Can Carpal Tunnel Go Away?

The carpal tunnel is a small channel of communication in the wrist that leads to the hand. It is encircled by the wrist bones below and the transverse carpal ligament across the top. The median nerve, which passes through the carpal tunnel, provides sensation to the thumb, forefinger, middle finger, and half of the ring finger. Many tendons, such as flexor tendons that allow hand mobility, run through the carpal tunnel.

• If these tendons that pass through the carpal tunnel thicken due to inflammation or other tissues, causing edema, can restrict the amount of space available inside the carpal tunnel.
• This causes squeezing of the median nerve, resulting in carpal tunnel syndrome and symptoms, such as pain, muscle cramps, numbness, and tingling along the nerve pathway.

If left untreated, the median nerve becomes squashed against the transverse carpal ligament, making the nerve irreparable. Carpal tunnel syndrome may affect either one or both hands.

The median nerve supports the thumb muscles. A person with advanced carpal tunnel syndrome may no longer be able to utilize or move their thumb effectively, such as reduced hand functions, and have difficulty grasping objects.

1. Paresthesia (tingling, pins and needles sensation)
2. Pain and burning sensation in the wrist
3. Reduced functions of the thumb
4. Squeezing pain at the wrist
5. Pain may radiate to other fingers and rarely, to the forearm and shoulders
6. Increased pain during nights
7. Sluggishness of the hand
8. Difficulty performing basic functions, such as holding objects
9. Thumb muscles may waste away
10. Loss of sensation to cold and heat may result in burning of the fingers

Flick sign is the most reliable sign to diagnose carpal tunnel syndrome. The patient often wakes up at night and shakes the wrist to help relieve the symptoms. If the pain is lost after a while, it indicates permanent sensory loss caused by nerve damage.

Reading the newspaper, holding the phone, or driving may increase symptoms.

Various reasons cause carpal tunnel syndrome, and, sometimes, the exact cause may not be known. It may be caused by one factor or a combination of more than one factor.

Some of the common causes of carpal tunnel include:

1. Arthritis: Any type of arthritis may increase inflammation within the wrist, leading to carpal tunnel syndrome.
2. Position of the wrist: Activities that cause extensive flexion or extension of the hand and wrist over an extended period might increase pressure on the nerve. This is seen in professional tennis players, piano players, and even those who lift weights without proper wrist support.
3. Overuse injury: Activities that increase the use of tendons or require repeating the same hand and wrist motions may harm the tendons in the wrist, causing inflammation, which exerts pressure on the nerve.
4. Pregnancy: Pregnancy hormones produce generalized fluid retention, which can compress the nerve. Carpal tunnel syndrome caused by pregnancy usually resolves quickly after birth.
5. Trauma: Trauma that causes fractures around the wrist may scatter bone pieces in the carpal tunnel. These may irritate the smooth membrane around the tendons called tenosynovitis. The space in the carpal tunnel may be reduced following swelling or edema, leading to carpal tunnel syndrome.
6. Hormonal imbalance: Hormonal imbalances caused by overexpression of the pituitary gland or reduced function of the thyroid gland may lead to carpal tunnel syndrome. Metabolic disorders related to diabetes and obesity are also risk factors for carpal tunnel syndrome.
7. Congenital factors: This is most certainly a significant factor. The carpal tunnel may be smaller in some people, or anatomic abnormalities may alter the amount of space for the nerve, and these qualities can be passed down to generations.

Early diagnosis and treatment have a good prognosis because damage to the median nerve can be avoided.

• Physical examination
  • A physical examination of the hands, arms, shoulders, and neck can help determine the presence of difficulties while performing daily activities or an underlying condition. Other disorders that resemble carpal tunnel syndrome can be ruled out by a doctor.
  • Tenderness, swelling, warmth, and discoloration of the wrist are all evaluated. Each finger's feeling should be evaluated, and the muscles at the base of the hand should be inspected for strength and symptoms of atrophy.
• Radiological imaging
  • Ultrasound imaging can reveal aberrant median nerve size
  • X-rays can detect fractures, arthritis, and nerve problems
• Nerve conduction studies
  • Electrodiagnostic tests may aid in the confirmation of carpal tunnel syndrome. Electrodes are put on the hand and wrist during a nerve conduction investigation. Small electric shocks are delivered, and the rate at which nerve impulses are sent is measured.
  • Electromyography involves inserting a small needle into a muscle and observing electrical signals on a screen to detect the amount of median nerve injury.

Specific tests for carpal tunnel syndrome

• Tinel test
  • The doctor taps or presses on the median nerve in the patient's wrist. If tingling in the fingers or a shock-like sensation occurs, then the test is said to be positive.
• Phalen or wrist flexion
  • The patient is asked to hold the forearms erect while pointing the fingers down and squeezing the backs of the hands together. If one or more symptoms, such as tingling or increasing numbness, are noticed in the fingers within a minute, carpal tunnel syndrome is suspected.
  • Doctors may sometimes instruct patients to perform a movement that causes the symptoms.

Carpal tunnel syndrome cannot be managed easily. The pain and stiffness may be mild at first. However, they may worsen to the point where the hand hurts all the time.

If the underlying reason is not addressed, one may sustain irreparable damage.

Nonsurgical options

• Resting the injured hand for at least 48 hours is essential
• Physiotherapy using active and passive exercises
• Use of splints at night on the affected wrist and hand
• Diuretic medicines are used to reduce fluid retention in the body by increasing the amount of urine discharged
• To minimize swelling, a local anesthetic and corticosteroid medicines are injected into the affected area

Surgery

Surgery may be the ultimate option to treat carpal tunnel syndrome and is usually done under the influence of local or general anesthesia.

• A small incision is made in the palm or on the wrist.
• The transverse carpal ligament is exposed.
• This ligament is manipulated to relieve strain on the underlying median nerve.
• The incision is sutured.
• Sometimes, the surgeon may operate on one or both wrists simultaneously.
• The pain and numbness may go away quickly or gradually.
• Immobilization of the wrist for a few weeks is the key to healing.
• Symptoms, such as pain, can be managed with pain medications.