Carpal tunnel syndrome

Carpal tunnel syndrome

Carpal tunnel syndrome is a pinch of the central nervous nerve (the so-called median nerve) at the level of the wrist. This nerve runs through a narrow channel: the carpal tunnel. The bottom of the carpal tunnel is formed by the carpal bones and the roof by a sturdy tendon leaf between the thumb and little finger mouse at the start of the palm. Various tendons, blood vessels, and the middle nerve run in this carpal tunnel.

If the central nervous nerve in this tunnel is clenched, it can no longer perform its function, causing problems with the sensation and strength of a part of the hand. One in ten people will experience carpal tunnel syndrome during their lifetime. Women three times as often as men.

Carpal tunnel syndrome can occur at all ages but mainly occurs in people between forty and sixty years of age. Women have an increased chance during pregnancy, usually from the sixth month. Carpal tunnel syndrome often occurs on both hands at the same time and one hand is usually affected more than the others. People who work a lot with their hands are more likely to develop carpal tunnel syndrome.

Carpal Tunnel Syndrome Symptoms

Because the middle arm nerve is pinched, it can no longer perform its function properly. The following symptoms may then occur:

  • irritations in thumb, index, middle and ring finger
  • these stimuli wake up at night
  • shaking hands reduces the stimuli
  • pain complaints in the wrist radiating to the hand or forearm
  • morning stiffness and awkwardness of the hand
  • reduced strength in the fingers
  • working with the hands aggravates the complaints
  • the muscles of the hand and thumb can become thinner

Often the symptoms start on one hand and later they extend to the other.

How does carpal tunnel syndrome arise?

If the nerve has too little space in the carpal tunnel, it can be pinched. This pinch can be caused by:

  • a narrow space in the carpal tunnel from birth
  • irritation of the nerve which makes it thicker and takes up more space
  • hormonal changes (such as during pregnancy, menopause, thyroid problems or excessive growth hormone) whereby more fluid is retained in the connective tissue and the space in the tunnel also becomes smaller
  • extra structures in the carpal tunnel that normally do not run there: a muscle, a tendon or a blood vessel that also takes up space
  • a wrist fracture or distortion of the wrist due to rheumatism
  • damage to the nerve by another disease (such as diabetes) which makes it extra susceptible to pinching

Because the nerve is pinched, the nerve’s blood supply is disturbed. As a result, the nerve cannot function normally and the function of the nerve fails.

The middle arm nerve controls the feeling and strength in the thumb, index, middle and ring finger. These functions can, therefore, be disrupted or lost.

When to the doctor?

If you suspect that you have carpal tunnel syndrome, you should contact your doctor. This will examine you and initially give you advice on how the nerve can settle again. If the symptoms are not reduced after six weeks, the doctor will refer you to the neurologist for examination and treatment.

Is it serious and what can you expect?

Spontaneous recovery Because the nerve is trapped in the carpal tunnel, it cannot function properly. In some people, the cause of the crush disappears spontaneously. The nerve can then recover and the symptoms of carpal tunnel syndrome can disappear. Nerves recover slowly; the recovery can, therefore, take a few weeks.

A carpal tunnel syndrome that develops during pregnancy generally resolves itself after pregnancy.

To the neurologist If the doctor suspects that you have carpal tunnel syndrome, he may refer you to the neurologist. Some hospitals have special outpatient clinics for carpal tunnel syndrome. The neurologist will listen to your symptoms, ask you questions and examine you neurologically. Often an investigation will follow in which electrical currents will be used to measure whether the nerve is in a pinch, where the nerve is in a pinch and how serious the pinch is. This research is also called muscle nerve research or EMG.

Night Splint If the nerve is indeed in a fix is in the carpal tunnel, you are prescribed a night splint. This is a splint that holds the wrist in a certain position with the space in the carpal tunnel being the largest. In this way, the nerve is given space and can recover. You only need to wear the splint at night. During the day it is also allowed, but then you cannot use your hand.

The splint must give a good improvement in your symptoms within four weeks. This is the case with six out of ten people. If the splint has not improved after this period, a different treatment is required.

Other treatments Other treatment options are an injection of an analgesic and anti-inflammatory drug near the carpal tunnel, treatment with anti-inflammatory tablets or a treatment that involves stretching the pinched nerve. These treatments give rather varying results so that not all hospitals perform them.

Surgery If all these treatments have no effect or if there is a severe carpal tunnel syndrome at the EMG, surgery may follow. The carpal tunnel is then opened and then enlarged by cutting the tendon leaf at the top of the carpal tunnel. This operation can be performed by a neurosurgeon, a plastic surgeon, or an (orthopedic) surgeon. Eight to nine out of ten people are then free of complaints. After the operation, you cannot use your hand normally for a few weeks. That is why two hands are never operated on at the same time.

What can you do about carpal tunnel syndrome yourself?

If you notice that you have symptoms of carpal tunnel syndrome, it is important that the nerve settles down. The following advice can help you with this:

  • pay attention to the use of your hands. Perhaps you can discover which movements cause pain and irritation. Try to avoid these movements for a few weeks
  • especially movements, where force must be applied by hand while the fingers are being moved, are often not good for people with carpal tunnel syndrome. Let others, such as wringing, peeling potatoes or screws, turn over
  • also holding a handlebar of the bicycle or car for a long time is a position in which the nerve is easily pinched. Try to alternate this position and not keep it up for too long (maximum 30 minutes)
  • ensure regular alternation while moving the arms. Divide a task where you often have to work with your arms into shorter tasks and take breaks
  • you can give the nerve a rest at night by bandaging your wrist in the position where you have the least trouble or by wearing wrist protectors that are also used for rollerblading at night
  • together with a physiotherapist you can look at your posture and receive tips and exercises to improve your posture
  • If you experience carpal tunnel syndrome symptoms on your workdays, in particular, it makes sense to look critically at your workplace and to avoid prolonged work with bent wrists and fingers. Call in the health and safety expert if necessary.

If after six weeks you still have symptoms of carpal tunnel syndrome, contact your doctor.

General advice and precautions for carpal tunnel syndrome

If you suffer from diabetes, disturbed thyroid function, rheumatism, are pregnant or are in transition, you are extra sensitive to develop carpal tunnel syndrome. Even if you have no complaints, it makes sense to look critically at how you are holding your hands while working. By learning a good posture you can prevent you from getting carpal tunnel syndrome symptoms.

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