Carpal tunnel syndrome is the most common cause of numbness, tingling and pain in the hand. Typically, they occur in the thumb, index and long fingers. They occur off and on in the beginning but as time passes, they become constant. The symptoms are aggravated at night as the wrist tends to assume bent position in sleep. Keeping the wrist in a straight position with a splint or a brace relieves the symptoms. Very often, but not always, the pain radiates to the elbow, shoulder or the neck. The pain may be sharp, dull, burning, hot or cold. Often the patient says that the hand and fingers feel swollen, tight, like sand paper or like feeling the finger through gloves.
As the patient starts to lose sensation, things start falling out of the hand.
THE HAND IS NOW IN TROUBLE!
What the Doctor Does
The diagnosis is established in most cases with a simple examination of the hand. Making a tight fist for one minute reproduces numbness, tingling or pain. Bending the wrist fully for one minute also reproduces the above symptoms. Finally manual pressure on the nerve at the wrist crease reproduces the symptoms.
Numbness and tingling can be caused by pressure on the nerve along the nerve from the neck to the finger tips. The pressure is usually caused by a tight band of tissue called a ligament. The location of nerve pinching can be confirmed with an office test called nerve conduction test. It measures the speed at which the electricity flows in the nerve. It takes about ten minutes to do. No needles are used when the test is done with the modern machines.
Treatment
The first line of treatment is splinting and two to three cortisone injections. The cortisone amount is so minute that it does not cause any side effects. One need not worry about gaining weight with injections. We try this for a month. If the symptoms are distressing, surgery is the last resort.
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