Carpal Tunnel Syndrome 

by 
drdoc on-line

Carpal tunnel is due to a compression of the median nerve as it crosses the wrist and enters the hand. At that point there is a fibrous band (flexor retinaculum ) which is non elastile and wrist swelling results in median nerve compression against the band.

It is frequently seen in females and is often worse in the morning on waking up. Other occupational causes are described including computer mouse / typing .
Some diseases may present with it - especially hypothyroidism and Rheumatoid arthritis. It may be seen post pregnancy.

It is characterized by numbness / tingling / weakness in the fingers. Usually the first three fingers are affected the most , but the whole hand can be affected. It can occur bilaterally. It is worse in the morning and may be relieved by shaking the wrists.

The problem can be confirmed by a nerve conduction study - which a neurologist would do.

The therapy is :

Treat the cause -ie- repetitive stress syndromes / hypothyroidism / Rheumatoid etc..
A wrist splint may be of benefit. I use the futuro wrist splint.
A short course of a diuretic may help including hydochlorthiazide 12.5mg / day .
If that doesn’t help...some people inject around the band - but I don’t personally recommend this. At this stage I’d rather recommend surgery, where the band is divided by a incision over the front aspect of the wrist and slightly into the palm.
It is a relatively small operation and may be done under a regional anaesthetic block.

A neglected severe carpal tunnel may produce wasting of the muscles in the hand and therapy can be less than perfect regarding final outcome.

What about Carpal tunnel in Rheumatoid Arthritis ?

This is a common problem in RA, and in fact often preceeds the initial presentation of the arthritis itself. The swelling of the synovium -the joint lining - at the wrist - causes the median nerve compression. Therapy of the swelling - by treating the arthritis - frequently resolves the carpal tunnel symptoms and therefore avoids the need for surgery.

Frequently asked questions of Rheumatoid arthritis patients :

If I do nothing, what is the possible scenario?

Answer -IF the CARPAL TUNNEL (CT) causes ongoing pain and weakness and it is not sorted out - ie for months to years -( the length of time varies depending on the severity of the compression and symptoms ) - permanent pain and weakness can follow as the nerve becomes permanently damaged despite release. However if your symptoms are mild and there are no signs of neurological benefit.... then you can observe progress without an urgent need for surgery.

Can I simply learn to live with it?

Answer - as long as you dont have WEAKNESS in the fingers from paralysis or numbness - suggesting significant compression to the nerve. If its ONLY symptoms of discomfort - you can.

Will the RA make it worse

Yes - the cause -IS the swelling at the wrist obstructing the nerve.

CAN I USE ANY OTHER THERAPY: (I know you meant to ask this)

YES- YOU CAN : If a splint and medications haven't helped - Ask your doc about a wrist joint injection of corticosteroid and local anaesthetic. That will usually get the swelling down and thereby help the carpal tunnel.