Carpal Tunnel Syndrome: Information on Treatment & Recommended Doctors

Carpal tunnel syndrome refers to the compression of the median nerve, which occurs in the carpal tunnel in the area of the wrist and on the inner side of the wrist. This nerve runs from the shoulder through the upper and lower arm.

The carpal tunnel is located on the inner side of the wrist. The median nerve, as well as various ligaments and tendons, pass through this tunnel.

Carpal tunnel syndrome is relatively common and often affects both hands. Children are rarely affected, while it occurs more frequently in people between the ages of 40 and 70. Statistically, women are affected more often than men.

Since this is a nerve compression syndrome, pressure on the median nerve can lead to various symptoms.

Carpal tunnel syndrome is usually caused by a narrowing of the carpal tunnel, which can be exacerbated by inflammation, changes in the cervical spine, or high external pressure. Injuries near the wrist are often the cause.

Other risk factors include

• rheumatism (conversely, rheumatism can be a sign of carpal tunnel syndrome),
• diabetes mellitus,
• physical strain,
• hormonal disorders,
• obesity, and
• thyroid problems.

Increased fluid retention in the joints and thickening of the ligamentous structure can also contribute to carpal tunnel syndrome. People with kidney failure who require dialysis are also at higher risk. Carpal tunnel syndrome often occurs on the side where the shunt is located.

Strain on the hand also plays a role. Certain occupational groups are affected more frequently. These include road construction workers who, for example, perform tasks using a jackhammer. The risk of developing carpal tunnel syndrome increases with regular, heavy strain on the wrists.

The symptoms also vary widely. Unfortunately, many people do not take the first signs seriously enough.

In the early stages, the hands may go numb, even at night. Often, additional sensations such as numbness, pain, or a painful tingling sensation occur. This sensation often begins in a single finger and then spreads further and further. The tingling may also be accompanied by symptoms such as pain and swelling. Tactile sensitivity and the sense of touch can also be affected.

If those affected ignore these signs, more severe damage is inevitable. In extreme cases, paralysis may even occur.

In advanced stages, muscle atrophy also occurs. A typical sign is atrophy of the muscles at the base of the thumb, which can significantly limit wrist mobility and grip strength. 

Generally, the symptoms often present in very different ways. Damage on the other side of the body may, under certain circumstances, not become apparent until much later. In some cases, both hands are even affected at the same time.

Occasionally, the symptoms may improve on their own. However, the underlying problem—compression of the nerve—persists.

The treating physician will perform a carpal tunnel syndrome test to gain a more accurate picture of the symptoms.

The following symptoms may occur with carpal tunnel syndrome:

• Tingling in the fingers and hands
• Pain
• Swelling
• Muscle wasting and reduced grip strength
• Symptoms of paralysis

Treatment for carpal tunnel syndrome varies depending on the stage and may be conservative or require surgery. For mild to moderate symptoms, treatment may include immobilizing the wrist with a splint worn at night, anti-inflammatory medications, laser therapy, or magnetic field therapy.

The primary focus of treatment is addressing the underlying condition. If, for example, diabetes is the cause of carpal tunnel syndrome, the diabetes must be treated.

To relieve acute pain, measures such as immobilizing the affected arm or taking medication are used simultaneously.

If excessive strain is the cause of carpal tunnel syndrome, the arm should be rested. This allows the nerves and other structures to recover. At the same time, anti-inflammatory medications or cortisone injections can provide relief.

Carpal tunnel surgery is recommended in advanced stages or when symptoms are severe. The surgery can be performed either as an open procedure or arthroscopically. The advantage of minimally invasive surgery is that the patient can move their hand sooner.

During the procedure, the carpal ligament—which lies over the bony groove at the wrist—is typically cut. The surgeon also removes tissue that may be compressing the nerve. This reduces the pressure on the nerve.

After surgery, the patient must rest the arm for several weeks. The duration of rest from sports or work depends on the healing process and the level of strain the hand is exposed to in the patient’s professional or athletic life.

If you have carpal tunnel syndrome, it is advisable to consult a specialist. A specialist in hand surgery is the first point of contact. In many cases, the hand is first examined clinically before a decision is made regarding outpatient or surgical treatment. However, since nerves are also involved in carpal tunnel syndrome, a neurosurgeon is also required.