Carpal Tunnel Syndrome

Carpal  Tunnel Syndrome

Dr Arun Oommen 
Consultant Neurosurgeon, 
Lakeshore Hospital and Research Centre
Kochi, India

Dear Doctor,
I am a 42-year-old lady living in Chennai. I have been suffering from recurrent numbness and tingling of the middle, index and thumb of my right hand. It gets aggravated especially when I use computers for a long period. I have consulted doctors and have done nerve tests and taken medicines. They gave only temporary relief. Recently my doctor adviced surgery to relieve the problem. I am not comfortable with the idea of a surgery. Is surgery really required?
-Sruthi Karunakaran, Kollam

Dear  Sruthi,
You seem to be having Carpal tunnel syndrome which is a very common problem faced. The carpal tunnel is an anatomical compartment located at the base of the palm. Tendons and a nerve called the median nerve pass through the carpal. The median nerve provides feeling or sensation to the thumb, index finger, long finger, and half of the ring finger. The median nerve can be compressed by a decrease in the size of the canal, an increase in the size of the contents (such as the swelling of lubrication tissue around the flexor tendons), or both.
Patients experience numbness, tingling, or burning sensations in the thumb, the index, middle fingers, and radial half of the ring fingers (median nerve distribution) which is the hallmark neuropathic symptoms (NS) of carpal tunnel entrapment syndrome. Weakness and atrophy of the thenar muscles may occur if the condition remains untreated.
Most cases of CTS are of unknown causes (idiopathic). Carpal Tunnel Syndrome can be associated with any condition that causes pressure on the median nerve at the wrist which  include obesity, oral contraceptives, hypothyroidism, arthritis, diabetes,), and trauma.. Occupational risk factors of repetitive tasks (continuous use of computer), force, posture, and vibration have been cited. 
If history and physical examination suggest CTS, patients can be tested electrodiagnostically with nerve conduction studies and electromyography. Electrodiagnostic testing is to compare the speed of conduction in the median nerve with conduction in other nerves supplying the hand. When the median nerve is compressed, as in CTS, it will conduct more slowly than normal and more slowly than other nerves. 
Generally accepted treatments include: steroids either orally or injected locally, splinting, and surgical release of the transverse carpal ligament. Predisposing illness like diabetes mellitus, coexistent cervical radiculopathy, hypothyroidism, polyneuropathy, pregnancy, rheumatoid arthritis, has to be tackled.
Surgery is recommended that when there is static (constant, not just intermittent) numbness, muscle weakness, or atrophy, and when night-splinting no longer controls intermittent symptoms. Release of the transverse carpal ligament is known as “carpal tunnel release” surgery. 
Suggested healthy habits such as avoiding repetitive stress, work modification through use of ergonomic equipment (wrist rest, mouse pad), taking proper breaks, using keyboard alternatives (digital pen, voice recognition, and dictation), and drugs like omega-3 fatty acids, and B vitamins have been proposed as methods to help prevent carpal tunnel syndrome.

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