Carpal tunnel syndrome

Introduction

Carpal tunnel syndrome refers to a neurological condition that is characterized by tingling, weakness or numbness in your hand. The condition arises due to the pressure being exerted on the media nerve. This is the major nerve in the hand. It extends from the upper arm, down the wrist via the carpal tunnel onto the hand. One of the key functions of the median nerve is to control hand movement. The median nerve also controls the movement of your fingers.

The carpal tunnel refers to a narrow passageway on the palm of the hand. Numerous ligaments and bones surround the carpal tunnel. Carpal tunnel syndrome manifests in such symptoms such as a sharp piercing pain that begins from the wrist and then moves up the arm.

Causes of carpal tunnel syndrome

If the tissue inside the carpal tunnel is swollen, this adds pressure on the median nerve. This results in pain. The swelling could be due to several causes, including exerting pressure on the wrist.

People who partake in repetitive activities like typing may also exert pressure on the median nerve. Individuals who are fond of extending their hands or wrists for long periods may trigger the development of carpal tunnel syndrome. Rheumatoid arthritis, diabetes and thyroid gland imbalance are also risk factors for developing carpal tunnel syndrome. Thankfully, the condition can be treated with the use of home remedies, homeopathic medicine, allopathy and surgery. The choice of treatment depends on the stage of carpal tunnel syndrome and whether there are other underlying conditions.

Types of carpal tunnel syndrome

Carpal tunnel syndrome is categorized into three stages:

• Stage 1: This is the mild form of carpal tunnel syndrome. It manifests as pain, and tingling sensation. Patients may experience numbness around the affected region. In particular, the tingling and pain tends to increase at night. A mere shaking of the hand will relieve such tingling. You are also likely to feel stiff in the affected hand upon waking up.
• Stage 2: This is the moderate form of carpal tunnel syndrome. With this type of carpal tunnel syndrome, the symptoms often worsen during daytime. They are exacerbated by repetitive hand movement or when the hand remains in a certain position for a prolonged period. With time, the hand gets weaker and you are likely to drop things.
• Stage 3: This is the severe form of carpal tunnel syndrome. By this time, the weakening of the hand is irreversible. The median nerve may also stimulate a wasting away of the hand muscles (atrophy).

Treatment options

Some of the treatment options available for carpal tunnel syndrome include:

Home remedies

The following home remedies may be useful in managing carpal tunnel syndrome:

• Take a break: If you are involved in repetitive tasks such as typing it is advisable that you take a periodic break. As you take the break, stretch your hands, wiggle your fingers and move your wrists. This will ensure improved flow of blood.
• Splints: Wearing splints ensures your wrists remain straight. This avoids exerting pressure on the median nerve. Wear the splints in the evening as symptoms tend to worsen at night.
• Stay warm: Cold hands tend to get stiff and painful. Avoid this by wearing finger-less gloves. This will keep you warm all day long.
• Hand elevation: If the carpal tunnel syndrome is a result of fractures or pregnancy, elevating the hand is effective in managing the pain and reducing the tingling sensation.

Homeopathy

The following homeopathic remedies are used in treating carpal tunnel syndrome:

• Rhus toxicodendron: This particular remedy is helpful in case the pain and stiffness worsens on initial motion but gets better with continued movement. You are cautioned not to overuse this remedy as it can cause pain, soreness and increased stiffness.
• Viola odorata: The remedy has proven helpful for numbness and pain of both hand and wrist. Such pain may also extend to the fingers. In addition, it could cause trembling. Cold weather exacerbates the symptoms.
• Ruta graveolens: This particular remedy is recommended when nerve irritation causes significant stiffness. The conditions may also present with stiffness that does not subside even after allowing your wrist to rest. Repetitive tasks lead to weakness of wrists and arms, mainly because of wear and tear of nerves and joints. This usually indicates Ruta.
• Arnica: The remedy is ideal for an outburst of new injuries or inflammation after using your wrists or fingers repeatedly. The affected area feels sore and bruised. You may also experience crumping.
• Causticum: This homeopathic remedy is beneficial for recurring or long-lasting carpal tunnel syndrome. You are likely to feel a burning pain or bruising around the affected area. The muscles of the forearm and hand may also contract and feel weak.
• Hypericum: This remedy is recommended for managing shooting or sharp pain in your hand. Such pain is also likely to extend from the wrist upwards. Hypericum soothes this type of pain.  

Allopathy

Your doctor can prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to help to manage the pain. This prescription is for a short period. Examples of NSAIDs that are widely used for treating carpal tunnel syndrome include ibuprofen.

A corticosteroid injection may also help with relieving the pain. In this case, corticosteroids are useful in reducing the swelling and inflammation. This will in turn, ensure that the median nerve does not feel pressured.

Procedures/methods available under surgery

Most of the non-surgical treatments for carpal tunnel syndrome do not address the underlying causes of the illness. They only offer temporary relief. As such, they do not offer a long-term solution to the problem. If the aforementioned non-surgical treatment fails to treat the condition, your doctors will most likely recommend that you undergo a surgical procedure. In arriving at such a decision, your doctor will assess the severity of the symptoms and the stage of the carpal tunnel syndrome. Some of the most widely practiced surgical procedures in treating carpal tunnel syndrome include:

Open release

This is the conventional surgery to treat carpal tunnel syndrome. During this procedure, the surgeon makes a 2 inch deep incision that extends from the wrist up to your palm. In this way, the surgeon is able to see clearly the transverse carpal ligament. The surgeon then cuts the carpal ligament using surgical instruments. The purpose of performing this procedure is to enlarge the carpal tunnel.

The procedure further relieves pressure off the median nerve. Consequently, it results in relieving symptoms associated with carpal tunnel syndrome. The surgeon will then close the skin using stitches. The surgeon leaves a gap and with time, it gets filled with scar tissue.

The procedure takes place under local anesthesia which further reduces the time spent at the hospital. Most patients are allowed to go home on the same day of surgery.

Endoscopic carpal tunnel release

During endoscopic surgery to treat carpal tunnel syndrome, the surgeon makes a single or two incisions near your wrist. The endoscope contains a tiny camera that the surgeon inserts inside the wrist. It will then display images on a monitor, In this way, the surgeon gets a clear image of the inside of your wrist. This will also help the surgeon to cut the transverses carpal ligament. Endoscopic surgery is associated with a high rate of recovery in comparison with open surgery.

Low lever laser therapy

This technique has found increased use in treating carpal tunnel syndrome due to its ability to promote nerve regeneration. Additionally, it helps to reduce inflammation, pain and promotes healing of damaged tissues in the affected wrists and hands. The technique uses deep near-infrared penetrating light and is less invasive, with no bleeding. Consequently, laser therapy promotes faster recovery.

Surgery options

We have many healthcare facilities in India that offer carpal tunnel syndrome surgery. You can choose to have the procedure at your doctor’s office, in a small clinic or at a large private or public hospital. Whatever be the choice, you will need consider few points while making a decision. These considerations include:

• Stage of carpal tunnel syndrome: The stage of the illness may dictate the type of surgery to undergo. Not all the facilities may offer all the different types of surgeries to treat carpal tunnel syndrome.
• Cost of surgery: The cost of carpal tunnel surgery varies depending on the facility where it is conducted, the surgeon, and whether you have an insurance cover. The consultation fees is also a determining factor of the cost of surgery.
• Surgeon’s experience: An experienced surgeon is likely to be in high demand, and this too, will dictate his/her consultation fees and/or availability

Surgery at a small clinic

If you choose to have surgery at a small clinic, there are certain benefits that comes with this choice over a large hospital. First, small clinics offer personalized attention because there are fewer patients being attended to. This is unlike in a large hospital that attends to hundred of patients each week. Second, small clinics do not experience delays in patient waiting time again because of a lesser volume of patients. The doctor is the main decision maker in the clinic and this further helps to avoid delays.

However, small clinics may be a disadvantage as they may charge more for the procedure in comparison with public hospitals. There is no consultation with other surgeons before surgery. This may limit the level of safety at a small clinic compared to a large hospital where there is close collaboration with other surgeons in decision-making.  

Hospitals

You can either choose to have surgery for your carpal tunnel syndrome at a private hospital or a public hospital. Such a choice could be beneficial because these facilities are well-equipped with the experts and equipment needed to conduct the procedure. Besides, the surgeons at large hospitals have conducted hundreds of related surgeries. This increases the success of surgery. In addition, large hospitals have a recuperating ward should it become necessary to get admitted for some time, so that your surgeon gets to observe your progress after the surgery.

In contrast, large hospitals experience delays due to, for example, having to make emergency operations. Also, you will probably miss out on the personalized care and attention offered at a small clinic.

Cost of carpal tunnel syndrome surgery in different setups

The cost of carpal tunnel syndrome surgery in India is determined by several factors, including the type of surgery, the city and kind of healthcare facility. Small clinics generally charge more than the large hospitals. In addition, the cost of surgery at a public hospital is subsidized than at a private or corporate hospital. The cost of carpal tunnel release surgery in Chennai ranges between Rs. 2,99,000 and Rs. 3,60,000. Surgery in Bangalore for carpal tunnel syndrome could go as high as Rs. 3,42,000.  While in Pune and New Delhi it costs Rs. 3,90,000 and Rs. 3,76,000, respectively.

Post-op care and things to keep in mind

After undergoing carpal tunnel surgery procedure, your surgeon will probably ask you to take it easy until you have fully recovered. This can take up to between 1 and 4 weeks, depending on the procedure that you underwent. The following activities will help you make a quicker recovery:

• Make it a habit to walk each day as this will promote blood flow and hence faster healing. Avoid lifting heavy objects until you have recovered.
• Your doctor will evaluate and permit taking a shower or bath  24-48 hours after surgery.
• Hand elevation after surgery is important to avoid stiffness and minimize swelling. It may be necessary to wear a wrist brace or splints for a few weeks post-surgery.

Best option

When going for surgery to treat carpal tunnel syndrome, you need a healthcare provider who can walk with you through the entire journey. goficure will hold your hand right from your appointment to diagnosis, treatment, and post-op care. We help you get appointments with specialists in carpal tunnel syndrome at a discount. goficure will also help fill out your paperwork and help with processing your insurance claim.

References