Carpal Tunnel Syndrome (Wrist Nerve Compression)
The structure known as the carpal ligament forms a tunnel together with the underlying wrist bones, protecting the tendons and nerves responsible for finger movements. This structure, called the carpal tunnel or wrist canal, is located at the wrist level and is covered at the top by a thick band-like tissue. The median nerve, the thickest nerve in the hand, also passes through this narrow and rigid tunnel. The median nerve is primarily responsible for the sensation and some movements of the thumb, index, middle, and part of the ring finger.
What Is Carpal Tunnel Syndrome?
If the tunnel narrows for any reason, the median nerve passing through it becomes compressed. As a result, the function of the nerve deteriorates, causing symptoms such as tingling, burning, and pain in the hand and wrist. This condition is called carpal tunnel syndrome.
What Causes Carpal Tunnel Syndrome?
Pressure on the nerve can occur in several ways. Swelling of the tendon sheaths that bend the fingers, joint fractures and dislocations, soft tissue trauma, vascular or muscular anomalies that reduce the tunnel’s volume, or postural causes like keeping the wrist bent for long periods can all lead to carpal tunnel syndrome. During pregnancy, about 25-35% of women may develop carpal tunnel syndrome due to edema, but it usually resolves on its own after delivery.
Who Is at Risk for Carpal Tunnel Syndrome?
It is more common in people who frequently perform repetitive and forceful hand and wrist movements during their work. This includes housewives who do a lot of handwork, bank employees and secretaries who frequently use typewriters or computers, and musicians. In addition, people with diabetes, hypothyroidism, rheumatic diseases, obesity, gout, and kidney failure are more likely to develop carpal tunnel syndrome.
Wrist fractures, soft tissue tumors, joint cysts, lipomas, and muscle or vascular anomalies can also cause compression in the carpal tunnel. Although it is not hereditary, carpal tunnel syndrome is four times more common in women over the age of forty than in men.
What Are the Symptoms of Carpal Tunnel Syndrome?
The condition usually starts with pain, which may sometimes radiate to the arm. Tingling, a sensation of itching, rapid fatigue, and weakness in the fingers are also common complaints, especially in the palm and fingers. The tingling may be severe enough to wake patients at night. Many patients report shaking their hands or rubbing their wrists to relieve the discomfort. Numbness is mostly felt in the first three fingers.
If not diagnosed and treated early, symptoms may worsen and persist throughout the day. Over time, difficulty in gripping objects and, in more advanced stages, muscle wasting in the palm may occur.
How Is Carpal Tunnel Syndrome Diagnosed?
Early diagnosis and treatment are crucial to prevent permanent damage to the median nerve. If permanent damage occurs, the fingers may lose their ability to move.
The median nerve originates from the spinal cord and may be compressed at any point from the spine to the fingers. Electromyography (EMG) is the only test that can determine where the problem is. EMG can detect whether the median nerve is compressed under the carpal ligament, the exact location of the compression, and its severity.
How Is Carpal Tunnel Syndrome Treated?
Carpal tunnel syndrome can be treated with surgical or non-surgical methods, depending on the stage of the disease.
If there is no underlying condition such as diabetes or hypothyroidism, the affected hand and wrist should typically be rested for at least two weeks. Activities that may worsen symptoms should be avoided or limited, and the wrist should be immobilized with a splint.
If swelling is observed in the wrist, cold therapy should be applied. Although ultrasound therapy, laser treatments, vitamin B supplements, and exercise therapy are sometimes tried, there is no strong evidence to support their effectiveness. Pain can be managed with NSAIDs (non-steroidal anti-inflammatory drugs). For persistent pain, local corticosteroid or anesthetic injections may be considered.
Wrist braces (resting splints) should be used, especially at night, in combination with anti-inflammatory medications. If symptoms persist for more than six months, surgical treatment should be considered.