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Pain and abnormal sensations on the palm, which sometimes radiate far up the arm, are often due to carpal tunnel syndrome. A complaint that is relatively widespread in our culture today. The symptoms are caused by compression of the median nerve, which passes through the so-called carpal tunnel in the area of the wrist. In view of the already cramped structures, the nerve can easily be pinched here if the surrounding tissue swells. Help is offered above all by sparing and manual therapies, but surgery may also need to be considered.
Carpal tunnel syndrome describes compression of the median nerve, which extends from the area of the 6th cervical vertebra to the first thoracic vertebra and extends into the fingers along the inside of the upper and lower arm. At the level of the wrist or the inside of the wrist, the nerve passes the carpal tunnel, which is enclosed by the carpal bones and the carpal ligament. As a result of the cramped structures, compression of the median nerve can easily occur, which leads to the symptoms of the carpal tunnel syndrome.
The median nerve supplies the palm of the hand and on the back of the hand the fingertips (up to the first joint) from the thumb to the ring finger. He also innervates the flexion muscles of the forearm. It is extremely important because it also provides for the gripping function of the thumb and index finger. The symptoms also correspond to its course and its care: those affected complain of sensations and pain in the fingers and on the inside of the hand, which can radiate up to the upper arm, shoulder and neck. Women before or during menopause are particularly affected.
The symptoms usually show up after a heavy load on the hands or wrist and begin with a feeling of numbness or tingling in the area of the median nerve. Pain in the form of the so-called brachialgia paraesthetica nocturna (pain during the night and early in the morning) is a typical symptom in the early stages. A high level of pressure sensitivity can also be observed. In the further course of the carpal tunnel syndrome there are often impairments of the muscles, which are supplied by the median nerve. In the morning in particular, the thumb, index and middle fingers feel stiff, the gripping force is lacking, the sense of touch is restricted and a pronounced feeling of numbness is noticeable. A breakdown of the muscles (atrophy) begins and especially the ball of the thumb begins to shrink visibly.
The median nerve can be depressed and irritated in several places on its way out of the cervical spine: by muscles on the side of the neck, between the first rib and collarbone, under the small pectoral muscle, in a muscle of the forearm and in the canal on the wrist (carpal tunnel) , in which the tendons of the flexors also run. The most common cause of nerve compression is an incorrect or excessive overload at all points.
In most cases, the carpal tunnel syndrome is triggered by strenuous activities with the hands (for example in the case of craftsmen) or prolonged incorrect posture (in the case of extensive cycling tours, for example). The associated swelling of the tissue in the already narrow carpal tunnel leads to pressure on the median nerve, which causes the nerve cells to die. In addition to anatomical impairments, such as previous bone fractures (carpal bones, spokes), arthrosis in the wrist or tendonitis and rheumatic complaints, systemic factors also count as systemic factors as risk factors for carpal tunnel syndrome. Diseases such as diabetes, an underactive thyroid or kidney problems are particularly worth mentioning here. An increased risk in pregnancy is also proven.
One problem is that many people do not take action and seek help at the first signs, but only in the late stages when the symptoms have become unbearable. This has often been preceded by long phases with sensory disorders or tingling and "falling asleep" in the hands. It is not uncommon to see a doctor only when the fingertips have become so insensitive in the advanced stage that those affected can no longer carry out finer work. It is important to react as soon as possible to the first signs of a carpal tunnel syndrome.
The diagnosis of carpal tunnel syndrome is usually relatively easy to make based on the symptoms. The tests can be provoked by certain tests, for example in which the wrist is bent or hyperextended, and the mobility of the thumb, index and ring fingers provide further information on the diagnosis. The occurrence of the so-called Hoffmann-Tinel signs when tapping along the nerve course is a relatively certain sign of the carpal tunnel syndrome. To determine the extent of damage to the median nerve, a measurement of the nerve conduction speed remains essential. In addition, imaging methods such as X-ray or ultrasound examinations are used to determine any anatomical causes of carpal tunnel syndrome.
Treatment of carpal tunnel syndrome
If there is an early reaction, temporary protection of the wrist is often enough to help the symptoms subside. If necessary, a wrist splint can also be used for immobilization. The use of cortisone is said to achieve tissue swelling in the event of massive compressions of the median nerve. So-called non-steroidal anti-inflammatory drugs (NSAIDs) can be used to treat pain and inflammation in severe forms.
It is not uncommon for those affected to have surgery to open the carpal tunnel, in which there is a surgical separation of the fascia of the carpal tunnel. Although the various variants of the procedure are now routine operations and most people have long-term solutions to the problem, they do not help all patients and it is advisable to try manual treatment throughout the nerve before an operation.
In addition to manual therapies such as osteopathy or Rolfing, various alternative methods are used in naturopathy to relieve the symptoms of carpal tunnel syndrome. For example, acute pain can often be alleviated with cold treatment. For this purpose, shredded ice cubes can be packed in a plastic bag and wrapped with a cloth, or ready-made cryopacks from the pharmacy can be used. Wraps based on healing earth can also be used, which are also intended to alleviate inflammation. Acupuncture with needles or with a laser is also very helpful.
In order to avoid the risk of renewed complaints in the long term, occupational therapy is highly recommended, especially for people who put a heavy load on their wrists. In this way, those affected learn to avoid errors and overloads. (tf, fp)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters, Barbara Schindewolf-Lensch
- Institute for Quality and Efficiency in Health Care (IQWiG): Carpal tunnel syndrome (accessed: August 13, 2019), gesundheitsinformation.de
- German Society for Neurosurgery (DGNC) e.V .: Carpal tunnel syndrome (accessed: August 13, 2019), dgnc.de
- German Society for Hand Surgery (DGH) / German Society for Neurosurgery (DGNC): S3 guideline carpal tunnel syndrome, diagnostics and therapy, as of June 2012, detailed view of guidelines
- Merck and Co., Inc .: Carpal Tunnel Syndrome (accessed: Aug 13, 2019), msdmanuals.com
- American Academy of Orthopedic Surgeons: Carpal Tunnel Syndrome (accessed: August 13, 2019), orthoinfo.aaos.org
- National Institute of Neurological Disorders and Stroke: Carpal Tunnel Syndrome Fact Sheet (accessed: August 13, 2019), ninds.nih.gov
- Cleveland Clinic: Carpal Tunnel Syndrome (accessed: August 13, 2019), my.clevelandclinic.org
- National Health Service UK: Carpal tunnel syndrome (accessed: 13.08.2019), nhs.uk
ICD codes for this disease: G56ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.