Wrist pain: carpal tunnel syndrome

By Yoo Youk-jin

Carpal tunnel syndrome is a progressively painful hand and wrist condition caused by overuse of the hand and wrist. It is one of the most common peripheral nerve diseases that can happen to the wrist, and it is 3 times more common in men than women. 50 percent of cases are bilateral and it could be related with workplace repetitive hand activities.

Typical symptoms of carpal tunnel syndrome include:

― Vague aching pain in distal, palmar surface of wrist

― More pain at night with wrist flexion

― Numbness, especially in thumb, index and middle finger but not in little finger

― Weakness and clumsiness of hand, even with decreased grip strength

― Symptoms relieved by ‘shaking out’ of the patients’ hands

Carpal tunnel syndrome occurs as a result of compression of the median nerve which is running through the wrist. The median nerve provides sensation to the palm side of hand and fingers, with the exception of the little finger. It also provides motor function around the base of thumb. When compression of the median nerve occurs, ischemia and mechanical disruption of nerve function may result.

In general, there is no single cause for the illness. Many factors could be associated with carpal tunnel syndrome. Anatomic reasons like previous history of wrist fracture or dislocation, inflammatory conditions and other medical conditions such as diabetes, hypothyroidism could be related.

Simple test can be performed for the diagnosis. If your pain and, or numbness, occur in the median nerve innervated fingers with one minute of wrist flexion (Phalen’s test), you have to consider carpal tunnel syndrome. Your physician may recommend an electromyogram and nerve conduction study if your symptoms and physical exams are not so clear. They are more sensitive measures of detecting compression of the median nerve and are also useful in differentiating from other illnesses.

Most of the patients can be relieved from their symptoms with conservative managements. These options are: avoiding repetitive trauma/vibratory tools, applying icepacks, wrist splinting, NSAIDs (only for the pain, but no evidence for the illness itself) and local or systemic corticosteroids.

However, if you have the symptoms for more than 10 months or constant numbness, or age over 50 years old, conservative treatment may not be sufficient. If you have positive Phalen’s test within 30 seconds, it could be another bad predictor.

Surgical decompression should be considered, if you have persistent symptoms refractory to conservative treatments or progressive motor weakness. It is effective than any other treatments for sustained carpal tunnel syndrome, as evidenced by improved subjective and objective long-term measures.

The author is a clinical instructor at the Seoul National University Hospital International Healthcare Center (SNUH-IHC).