Carpal tunnel syndrome: often seen, too often misdiagnosed

Carpal tunnel syndrome is a condition that can cause suffers considerable discomfort and pain if not treated correctly. Effective treatment is available, but often the syndrome is confused with other medical conditions causing unnecessary delays in treatment.

In this article, Dr Alf Neuhaus from the Clinica Sandalf in Spain discusses the problem of diagnosing the condition.

Visit Dr Neuhaus’ website.

What is carpal tunnel syndrome?

The Carpal Tunnel is the name for the area at the base of the wrist on the palm-side of the hand, through which nine flexor tendons for the wrist and fingers and one major nerve, the median nerve, pass. The walls of this tunnel are the bowl-shaped wrist bones on the bottom, and fairly thick tissue reaching across this bowl on the top half holding the tendons and nerve in place. Under normal conditions, the tendons can glide through the tunnel without any problems and do not affect the nerve.

Why is carpal tunnel syndrome misdiagnosed?

The symptoms in the early stages of the disease are not very specific. One of the first signs is tingling in the thumb, index and middle finger, and sometimes part of the ring finger. This is often first noticed at night and is sometimes confused with the hand going numb due to sleeping in an awkward position. As a result, the symptoms are often ignored. As the problem progresses, the sufferer will start to feel pins and needles in the area described above, followed by numbness. This is followed by increasing pain in the fingers and the wrist. At this stage, the patient will also notice weakness and loss of control, for example, difficulty in picking up and holding small objects.

What causes carpal tunnel syndrome?

The Median Nerve is one of three major nerves to the hand and is responsible for sensation and movement of the thumb, index and middle finger, as well as half of the ring finger. Like every big nerve it tolerates temporary pressure, but it cannot regenerate any damage suffered by injury or compression.

There are several causes of damage to the median nerve. These include direct injury, elbow dislocation, compression, bruising in the forearm, or neck injuries. Apart from these acute problems, chronic diseases such as rheumatoid and osteo-arthritis can also damage the nerve. The fact that a nerve can show symptoms of damage in any area along its path, down from the spine to the end of the limb, regardless where the origin of the problem, makes diagnoses extremely difficult.

How is carpal tunnel syndrome treated?

The treatment of carpal tunnel syndrome is normally straight forward once an accurate diagnosis has been made. In the early stages, although this could mean years after the first symptoms occur, local injections with cortisone to reduce inflammation and/or a night splint can help. If this does not help or if the disease is already in the advanced stage of pain, numbness and weakness, surgical release of the carpal tunnel is recommended. This can be done as out-patient surgery under a local anaesthetic. Under normal circumstances, the pain and numbness settle down within a few days and the patient can return to normal life after 3 - 4 weeks.

Does treatment completely cure carpal tunnel syndrome?

If treatment of the carpal tunnel syndrome is started in the ‘early’ stage of the disease, full recovery of the endangered nerve can be achieved.

Even in the later stages of the disease, the symptoms can be alleviated by surgically releasing the tight carpal tunnel.  This will make daily activities easier and restore a certain quality of life.

Profile of the author

Dr Alf Neuhaus, Consultant Orthopaedic Surgeon at Clinica Sandalf in Benalmadena in Spain started his orthopaedic training in Germany after qualifying as a physician. He continued his orthopaedic training in the United Kingdom.  In 2000, he opened the private outpatient clinic at Clinica Sandalf near Malaga, where he specialises in a variety of surgical joint treatments.

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