Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when the synovium swell,
putting pressure on the median nerve.
Causes
The carpal tunnel may be smaller in some people or there may be anatomic differences that change the amount of space for the nerve
Carpal tunnel syndrome is generally more common in women.
This may be because the carpal tunnel area is relatively smaller in women than in men.
A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist,
can alter the space within the carpal tunnel and put pressure on the median nerve.
Obesity is a risk factor for carpal tunnel syndrome.
Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve.
This is common during pregnancy.
Carpal tunnel syndrome associated with pregnancy generally gets better on its own after pregnancy.
birth control pills or hormone pills are risk factors
as they alter the levels of hormone in the body resulting in swelling in carpal tunnel and nerve compression
Working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve
Many times, there is no single cause of carpal tunnel syndrome.
It may be that a combination of risk factors contributes to the development of the condition.
Symptoms
You may notice t numbness, tingling, burning, and pain in your fingers or hand.
Usually the thumb and index, middle or ring fingers are affected,
but not your little finger.
You might feel a sensation like an electric shock in these fingers.
This sensation may travel from your wrist up your arm.
The numb feeling may become constant over time.
You may experience weakness in your hand and drop objects.
This may be due to the numbness in your hand or weakness of the thumb's pinching muscles, which are also controlled by the median nerve.
this may make it difficult to perform fine movements such as buttoning your clothes
These symptoms may wake you from sleep.
In most cases, the symptoms of carpal tunnel syndrome begin gradually—without a specific injury.
you find that your symptoms come and go at first.
Diagnosis
“The diagnosis is usually clinical; your doctor will ask you questions and review the pattern of your symptoms.
he will conduct a physical examination.
He will test the feeling in your fingers and the strength of the muscles in your hand.
Bending the wrist at 90 degrees for 60 seconds also called (Phalen’s test),
or tapping lightly over the median nerve at the wrist (volar aspect) (Tinel’s sign)
can trigger symptoms in many people with carpal tunnel syndrome.
X-rays are not helpful in making a diagnosis.
However, some doctors recommend an X-ray of the affected wrist to exclude other causes of wrist pain,
such as arthritis or a fracture.
nerve conduction study (NCV) can be ordered to identify any potential areas of blockage or compression,
In other cases, a doctor might conduct an Electromyography (EMG) to identify damage to the muscles controlled by the median nerve
Ultrasound helps check the median nerve for signs of possible compression.
blood tests may be ordered if there are other signs suggesting comorbidities.
such as diabetes or hypothyroidism,
Treatment
In the early stages, simple things that you can do for yourself may make the problem go away.
For example:Take more-frequent breaks to rest your hands.
Avoid activities that make symptoms worse.
Apply cold packs to reduce swelling.
Try to Lose weight if you are overweight or obese.
Your hand and wrist may be immobilized with a splint or wrist brace for 4 to 6 weeks,
These braces are often worn at night,
although they may also be needed during the day.
Nonsteroidal anti-inflammatory drugs (NSAIDs). may help relieve pain from carpal tunnel syndrome in the short term.
You may be referred to physiotherapy to be taught strengthening and stretching exercises.
Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve pain.
Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve.
Sometimes an ultrasound used to guide these injections.
In severe cases where non-surgical treatments have failed or muscle weakness has begun to occur,
surgical intervention may be needed to correct carpal tunnel syndrome. This procedure is known as carpal tunnel release
This procedure requires a small incision in the palm of the affected hand.
Through this incision, the surgeon can access the wrist
and split the transverse carpal ligament which serves as a roof at the top of the carpal tunnel under direct vision.
This opens the space and relieves pressure on the median nerve.

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