Carpal tunnel syndrome describes compression (pinching) of the
median nerve in the wrist area.
Median nerve is required for feeling and movement, while its
compression causes pain, numbness, weakness and swelling of the
thumb and some of the fingers of the hand.

Causes:
In
most cases no direct cause is found, often associated with:
- Wrist fracture
- Inflammation (swelling) due to rheumatoid arthritis
- Activities that regularly put strain on the wrist
INVESTIGATIONS
- Doctors will enquire about symptoms (felt by the patients
interpreted by the doctor or a nurse). Pressure may be applied to
various parts of the wrist and hand to determine extents of pain,
tingling and numbing effects
- Wrist X-ray:
- May be done to look for other conditions such as arthritis or
wrist fracture
- Electromyography (EMG):
- Small electrodes are attached to the skin, allowing the doctor
to observe the electrical conduction of nerves and resulting muscle
behaviour
- Some blood work and urine samples may be sent for analysis; to
see if there are any associated diseases, which are also risk
factors for carpel tunnel syndrome; e.g. diabetes, arthritis,
kidney failure etc.
TREATMENT
Initially the disease is treated conservatively such as:
- If associated with some other condition for example, diabetes
or thyroid problem treat the condition which is causing carpal
tunnel syndrome first
- Avoid provocative factors such as; working on the computers for
long hours
- Protecting the wrist by using gloves and support when working
with heavy tools to decrease the impact of force
- Splints may relieve stress on the nerve and decrease
numbness
Surgery:
Generally recommended if symptoms last for 6 months, surgery
involves severing the band of tissue around the wrist to reduce
pressure on the median nerve. Surgery is done under local
anesthesia (numbing the area where the surgery is supposed to be
performed).
Following are the different types of carpal tunnel release
surgeries:
Open release surgery: Requires an incision up to 2
inches in the wrist and the ligament (band like fibrous tissue;
connecting bones to other bones) is severed which runs across to
enlarge the tunnel. This aims to relieve pressure on the nerve. The
procedure is generally done under local anesthesia on an outpatient
basis. Although symptoms may be relieved immediately after surgery,
full recovery from carpal tunnel surgery can take months.

Note: Some may have infection, nerve damage,
stiffness, loss of strength at the wrist and pain at the scar. A
surgeon treat infection if present; and may advise physiotherapy
post surgically to build up the lost strength.
Endoscopic surgery: Requires 2 incisions (cuts) of
about ½ inches each; one in the wrist and the other in the palm. A
camera connected to the computer is attached to a tube (endoscope)
is inserted through the incision; display the structures on the
computer screen, with a cutting tool it cuts the ligament (band
like fibrous tissue; connecting bones to other bones) running
across to enlarge the tunnel. The procedure is performed under
local anaesthesia is effective with minimal scarring. Generally
allows individuals to resume some normal activities in a short
period of time.
Recurrence of carpal tunnel syndrome following treatment is rare.
The majority of patients recover completely.

Medications:
Oral agents:
- Such as oral steroids, non-steroidal anti-inflammatory drugs
(ibuprofen\naproxen) and diuretics (water pills)are widely used,
but there is no clinical evidence for their role except for some
temporary relief by reducing local swelling and pain
Steroid injections:
- May be given at the wrist, although research suggests, that
benefits are short term about 1-3 months. Some of the agents used
are hydrocortisone, methylprednisolone


Work
or activities which are stressful on the wrist such as: tennis,
knitters, use of vibrating tools.
Manage by:
- Stretching and taking breaks often
- Using splints and non-steroidal anti-inflammatory(NSAID)
drug
- Using gloves to lessen the impact of vibration during use of
vibrating tools
Medical conditions which may cause risk of developing carpal tunnel
syndrome
- Kidney failure
- Diabetes mellitus
- Menopause
- Pregnancy
- Thyroid problems
- Rheumatoid arthritis