Many people suffer from pain and tingling sensation on palmar aspect of hands and fingers. Mostly at night patient wake up during sleep due to these symptoms, medically termed as Carpal Tunnel Syndrome.
Carpal Tunnel is a narrow passage which is surrounded by bones and ligaments on the palmar aspect of the wrist. The extrinsic fingers & thumb flexor tendons and the Median nerve etc passes through this carpal canal. A decrease in size of the canal or increase in size of contents may cause compression of median nerve known as Carpal Tunnel Syndrome. The wrist joint may have swelling which may inturn exert pressure on median nerve passing through the carpal canal. The compression of this nerve may produce symptoms like pain, numbness, tingling sensation in middle, thumb and index finger. It is more prevalent during night probably due to the sleep positions. Some times tingling sensation may extend to shoulder and neck area.
Physical Findings as seen by physician :
Abnormalities in sensation or sensory loss may be present on the palmar aspect of the first 3 digits and radial one half of the fourth digit. Sensory loss and weakness on abduction and opposition of thumb.
Wasting and weakness of the hand muscles supplied by median nerve(LOAF muscles) may be detectable.
L – First and second lumbricals
O – Opponens pollicis
A – Abductor pollicis brevis
F – Flexor pollicis brevis
Atrophy and loss of Thenar emminence
Untreated Carpal Tunnel Syndrome may lead to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction
Conditions leading to Carpal Tunnel Syndrome
Simple clinical tests to confirm Diagnosis
Tinel Test :
Hold wrist in neutral or flexed position, tap or press gently over flexor retinaculum, a tingling sensation without pain is positive Tinal Test.
Phalen Test :
Make the patient hold dorsum of both hands opposite to one another with wrist maximally flexed and fingers pointing down for 60 seconds,tingling and numbness along the distribution of median nerve makes the test positive.
Symptomatic tratment for pain, numbness, swelling and Tingling sensation
Anti-inflammatory herbal or herbo-mineral combinations
Local formentation, Oil application, Poochu or medicinal bandage around wrist
Preventing Carpal Tunnel