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 in turn 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.
- Pain and weakness of hands and wrist.Pain prominent in palmar side of first 3 fingers and at times radial half of fourth finger
- Loss of grip
- Numbness, burning or tingling sensation in thumb, index and Middle fingers
- Cold hands
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
- Infections like Rubella
- Rheumatoid Arthritis
- Medial Artery Aneurism
- Ganglion Cyst
- Increased Fat
- Hypertrophy of Abductor pollicis brevis
- Diabetes Mellitus
Simple clinical tests to confirm Diagnosis
Hold wrist in neutral or flexed position, tap or press gently over flexor retinaculum, a tingling sensation without pain is positive Tinal 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.
Siddha Medicine & Treatment
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
- Depending on occupation, precautions are needed to be taken. If one is more engaged in writing work, frequent breaks of 10-15 minutes for gentle stretching of hands, fingers and wrist is useful. While working resting the wrist at neutral is the best.
- While working in key board, the wrist should not get compressed, better to elevate the elbow a bit higher or lower.
- Using correct posture is much needed by keeping the shoulders and neck straight and in position.
- Avoid cold exposure, always keep the hands warm
- Yoga and Relaxation Techniques
- Night splints around wrist is useful to avoid mid night waking up due to increased pain and tingling sensation.