Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when the tissue surrounding the flexor tendons (known as synovium) swells, putting pressure on the median nerve and reducing its blood supply.
This abnormal pressure on the nerve can result in numbness, tingling sensation, pain, and weakness in the hand.
Causes
Most cases of carpal tunnel syndrome are caused by a combination of factors. Women and older people are more likely to develop the condition.
Other risk factors for carpal tunnel syndrome include:
- Heredity. This is likely an important factor. The carpal tunnel may be naturally smaller in some people, or there may be anatomic differences that change the amount of space for the nerve and these traits can run in families.
- Repetitive hand use. Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
- Hand and wrist position. Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve.
- Pregnancy. Hormonal changes during pregnancy can cause swelling that results in pressure on the nerve.
- Health conditions. Diabetes, rheumatoid arthritis and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.
Symptoms
- Numbness, tingling sensation, burning sensation, and pain — primarily in the thumb and index, middle, and ring fingers. This often wakes people up at night.
- Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
- Pain or tingling sensation that may travel up the forearm toward the shoulder
- Weakness and clumsiness in the hand — this may make it difficult to perform fine movements such as buttoning your clothes
- Dropping things — due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space.
In most cases, the symptoms of carpal tunnel syndrome begin gradually, however, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.
When to see a doctor
See your health care provider if you have signs and symptoms of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Permanent nerve and muscle damage can occur without treatment.
Risk factors
- Anatomic factors. A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.
- Sex. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men.
- Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase the risk of nerve damage, including damage to the median nerve.
- Inflammatory conditions. Rheumatoid arthritis and other conditions that have an inflammatory component can affect the lining around the tendons in the wrist and put pressure on the median nerve.
- Medications. Some studies have shown a link between carpal tunnel syndrome and the use of anastrozole (Arimidex), a drug used to treat breast cancer.
- Obesity. Being obese is a risk factor for carpal tunnel syndrome.
- Body fluid changes. Fluid retention may increase the pressure within the carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause.
- Other medical conditions. Certain conditions, such as menopause, thyroid disorders, kidney failure and lymphedema, may increase the chances of carpal tunnel syndrome.
- Workplace factors. Working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage.
Diagnosis
- History of symptoms. Your provider will review the pattern of the symptoms. For example, because the median nerve doesn’t provide sensation to the little finger, symptoms in that finger may indicate a problem other than carpal tunnel syndrome.
- Carpal tunnel syndrome symptoms usually occur while holding a phone or a newspaper or gripping a steering wheel. They also tend to occur at night and may wake you during the night, or you may notice the numbness when you wake up in the morning.
- Physical examination. Your provider will conduct a physical examination. He or she will test the feeling in the fingers and the strength of the muscles in the hand.
Bending the wrist, tapping on the nerve or simply pressing on the nerve can trigger symptoms in many people. - X-ray. Some providers recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture. However, X-rays are not helpful in making a diagnosis of carpal tunnel syndrome.
- Ultrasound. Your provider may recommend an ultrasound of your wrist to get a good picture of the bones and nerve. This can help determine whether the nerve is being compressed.
- Electromyography. This test measures the tiny electrical discharges produced in muscles. During this test, your provider inserts a thin-needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest.
- Nerve conduction study. In a variation of electromyography, two electrodes are taped to the skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel.
Treatment principles
- Sroto vivarana chikitsa
- Vatanulomana
- Nadi balya oushadhas
- Marmma prasadana oushadhas
- Rujakara marma chikitsa
- Vatakapha hara ushadhas
- Viswachi chikitsa
Treatment modalities
- Abhyangam
- Ushna sweda-hot water bag
- Upanaha sweda
- Bandhanam
- Picchu
- Lepana
- Local dhara
- Nasya
- Agnikarmma
Internal Medicines
Kashaya
- Ashtavarggam Kashaya
- Bhadradarvadi Kashaya
- Dashamulam Kashaya
- Dasamularasnadi Kashaya
- Guggulutiktakam Kashaya
- Lasuna kshira Kashaya
- Maharasnadi Kashaya
- Mustadi marmma Kashaya
- Nadi Kashaya
- Prasaranyadi Kashaya
- Rasnadi Kashaya
- Rasna saptakam Kashaya
- Shunti baladi Kashaya
- Varanadi Kashaya
Arishta / Asava
- Aswagandharishta
- Balarishta
- Devadarvarishta
- Varanadyarishta
Churna
- Ellumnisadi churna
- Guggulu panchapalam churna (int)
- Jadamayadi churna
- Kottamchukadi Churna with dhanyamla-upanaham
- Nagaradi churna (external application- lepa)
Gulika/ Vati/ Guggulu
- Abha guggulu
- Karutta vattu
- Rasnadi guggulu
- Shaddharanam gulika
- Vyoshadi guggulu
- Yogaraja guggulu
Taila
- Asavenna
- Dhanwantaram taila
- Gandha tailam
- Karpasastyadi taila (nasya & ext)
- Karpuradi taila
- Kayatirumeni taila
- Kottamchukkadi taila
- Murivenna
- Panchasneham kuzhampu
- Pinyaka taila
- Prabhanjanam taila
- Supti taila (pt)
- Varanadi taila
Ghrita
- Dhanwantaram Ghrita Guggulutiktakam Ghrita
- Indukantam Ghrita
- Rasna dashamula Ghrita
- Varanadi Ghrita
Rasa/ dhatu/ Loha preparations
- Ekangavira rasa
- Mahavatavidhwamsani rasa
- Vatagajankuhsa rasa
- Vatakulantaka rasa
- Chandamarudha Chendooram
Prevention
- Reduce your force and relax your grip. If your work involves a cash register or keyboard, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink.
- Take short, frequent breaks. Gently stretch and bend hands and wrists periodically. Alternate tasks when possible. This is especially important if you use equipment that vibrates or that requires you to exert a great amount of force.
- Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. Keep your keyboard at elbow height or slightly lower.
- Improve your posture. Incorrect posture rolls shoulders forward, shortening the neck and shoulder muscles and compressing nerves in the neck. This can affect the wrists, fingers and hands, and can cause neck pain.
- Change your computer mouse. Make sure that your computer mouse is comfortable and doesn’t strain your wrist.
- Keep your hands warm. You’re more likely to develop hand pain and stiffness if you work in a cold environment. If you can’t control the temperature at work, put on finger less gloves that keep the hands and wrists warm.
Lifestyle and home remedies
- Take short, frequent breaks from repetitive activities involving the use of the hands.
- Lose weight if you are overweight or obese.
- Rotate the wrists and stretch the palms and fingers.
- Wear a snug, not tight, wrist splint at night. You can find these over the counter at most drugstores or pharmacies.
- Avoid sleeping on the hands.
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