Carpal tunnel syndrome

In carpal tunnel syndrome (KTS, also: carpal tunnel syndrome, CTS), a nerve becomes trapped on the wrist, the so-called middle nerve . This runs through the carpal tunnel, a kind of tube in the area of ​​the wrist. The middle nerve is responsible for enabling us to feel and grasp with our fingers.

If the tissue around the carpal tunnel swells, the median nerve no longer has space and triggers typical symptoms : those affected have the feeling that their hand is falling asleep and that they are going numb. This happens from time to time in healthy people and quickly passes again. With carpal tunnel syndrome, the hand keeps falling asleep. Patients often experience pain and numbness.

Carpal tunnel syndrome mostly affects peoples between the age of 40 and 70 . Women get sick a littles more often than men. The syndrome can appear on one hand or both hands. The likelihood that those affected will develop carpal tunnel syndrome on both sides is 20 to 50 percent.

Carpal tunnel syndrome: causes

Experts can say that carpal tunnel syndrome occurs because the median nerve in the wrist does not have enough space. But they do not know why the tissue around the carpal tunnel swells and triggers the typical pain that can sometimes radiate to the elbow. Medical professionals discuss the following causes:

• Predisposition : Since carpal tunnel syndrome often has several members of the same family, it is likely that the condition is hereditary. Sufferers are born with a narrowed carpal tunnel.
• Hormones : If the body's hormones change, for example during pregnancy or with thyroid disease, this can cause tissue in the hand to swell. 
• Previous illnesses : Certain clinical pictures such as rheumatism , diabetes , injuries to the wrist or inflammation of the tendon sheaths can promote carpal tunnel syndrome.
• Stress : People who have to bend or straighten their wrist extremely, for example when working with a jackhammer, doing assembly work or doing constant computer work, often have more severe symptoms.

Carpal tunnel syndrome: symptoms

The signs of carpal tunnel syndrome are:

• Numbness and tingling - sensation that the hand is falling asleep. The thumbs, index, middle and ring fingers are mostly affected.
• Pain in the hand that can radiate into the arm and, in individual cases, to the shoulder.
• Serious carpal tunnel syndromes that are not treated can lead to muscle wasting at the ball of the thumb over a long period of time . Patients have trouble grasping objects.

Symptoms mainly occur at night and in the morning . This is because people often bend their hands while they sleep. During the day, symptoms can be triggered by cycling, driving a car or making phone calls. If those affected shake hands, the symptoms usually subside.

Carpal tunnel syndrome: diagnosis

If your hand painfully falls asleep again and again, you should see a doctor. This carries out several tests. He first checks how flexible and sensitive the fingers and wrist are.

Doctors also usually use electroneurography to examine the wrist . They measure the speed with which nerves transmit a stimulus. If the speed is below a certain limit, the nerve works with a delay and there is a high probability that it is a carpal tunnel syndrome.

In addition, a can neurosonography (ultrasound) may be useful. On the ultrasound image, the doctor can see the nerve and the exact location of the constriction in the carpal tunnel. This makes it easier to decide on the right therapy.

 

In carpal tunnel syndrome, a nerve becomes trapped in the wrist, the so-called middle nerve. This runs through the carpal tunnel, a kind of tube in the area of ​​the wrist. The carpal ligament is a firm connective tissue structure that has a stabilizing effect. To give the middle nerve more space, the doctor can cut the carpal ligament

Carpal tunnel syndrome: therapy

If the person affected has mild to moderate symptoms, conservative remedies can alleviate the pain. If severe symptoms persist over a long period of time, surgery is the treatment of choice.

Carpal tunnel syndrome: treat without surgery

The doctor will first recommend a splint that the patient wears at night. This prevents the wrist from kinking while you sleep. Many patients sleep well through the night with the splint.

Affected people often use a bandage during the day. This is easy on the nerves and at the same time allows you to move your hand. However, it has not been proven whether taping helps with carpal tunnel syndrome.

In addition, the doctor often gives cortisone - in the form of tablets or as an injection directly into the wrist. The active ingredient can temporarily subside the symptoms. However, cortisone does not help against carpal tunnel syndrome in the long term.

If the pain is more severe, the doctor often also recommends using pain relievers or ointments. In some cases, pharmacists also recommend vitamin B6, which is supposed to strengthen the nerve. However, studies show that the vitamin does not improve symptoms.

Some patients use physical therapy and do certain exercises to relieve their symptoms. Studies have not yet been ables to prove whether these really help with carpal tunnel syndrome. The benefits of homeopathy have also not been proven. The same applies to acupuncture, ultrasound, laser and magnetic field therapy for carpal tunnel syndrome.

Carpal tunnel syndrome: OP

If the conventional treatments do not help even after several months and the patient has severe symptoms, an operation is an option. During the procedures, the surgeon cuts the carpal ligament in the wrist . This gives the middle nerve more space and is relieved . The surgeon usually performs the operation on an outpatient basis. That means, an overnights stay in the hospital is not necessary.

How quickly a patient becomes symptom-free after the procedure depends on how severe the carpal tunnel syndrome was. For most peoples, the symptoms subside after a few days. For others, it takes a few weeks to months. It helps to move the fingers in a targeted manner after the operation. Patients should avoid using a splint after the procedure.

Carpal tunnel syndrome: course

How long those affected are sick varies greatly. For some, symptoms resolve after a few months without treatment. Others have recurring complaints. If the course is severe , the muscles in the ball of the thumb break down. Patients may then have persistent problems grasping things such as a key or a glass.

Carpal Tunnel Syndrome: Which Doctor?

If you feel a tingling sensation or pain in your hand, your general practitioner is the first person to contact. They will examine you carefully and rule out possible other causes such as wrist injuries or rheumatism.

If the suspicion of carpal tunnel syndrome is confirmed, your family doctor will refer you to a neurologist . This carries out further investigations. It will measure the nerve conduction velocity of the hand (see section "Carpal tunnel syndrome: diagnosis"). If an operation is due, your family doctor will recommend a neurosurgeon .

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