Dr K K Pandey
If you have been quite often or always suffering from pain, burning, tingling, or loss of sensation either in your thumb or Index finger or Middle and ring finger or sometimes you might have complained of recurrent episodes of sudden jerks simulating mild electric shocks in these fingers. Sometimes you complain of emerging of pain in hand then after some time reaching up to shoulder. Many times, patient complains of weakness and sluggishness in finger movements, making difficult to do fine works like threading a needle or buttoning the shirts. Sometimes it becomes difficult to hold an object and even then the moment you have held it, it falls down on the ground after slipping from your hand. If you are suffering from any of these above-mentioned problems, believe me in all probability, you are suffering from carpel tunnel syndrome and you should without any further delay consult a vascular surgeon.
What is this carpel tunnel syndrome all about?
This is one of the important reasons for painful and pitiable condition of hand. This condition develops when especially, an excessive pressure is built up in the area of wrist over nerves especially median nerve. If timely treatment of this problem is not undertaken, it may lead to permanent damage to muscles in the wrist. In the beginning this problem starts with pain and tingling sensation in the fingers followed by painless intervals in between. But gradually as the time passes, this problem of pain become persistent without any intermittent relief. A person suffering from carpel tunnel syndrome is unable to sleep during night, and the sufferer undergoes a lot of mental tension and depression.
Who are the people suffering from the problem?
This has been observed among those persons involved in a profession where there is a constant movement of hand and fingers like car and bus driver writer & computer personnel. This problem of carpel tunnel syndrome has also been observed, among pregnant ladies, oldies, diabetics. Alcohol addicts and persons undergoing regular dialysis suffer the most from this problem. Persons suffering from hypothyroidism or rheumatoid arthritis or gout, quite often fall victims to this problem of carpel tunnel syndrome. If anybody during a road traffic accident has suffered from wrist fracture or displacement of wrist joint bones, he might possibly suffer from this problem. If there is a structural or anatomical abnormality of wrist, one can possibly suffer from carpel tunnel syndrome. It has been observed, this problem runs in some families from one generation to another.
How to recognize this problem?
If you feel pain, tingling sensation in hand and finger during night time, or you feel difficulty in writing or using keyboard on computer, or you feel difficulty in knitting or embroidery, or very recently have been feeling weakness in hand, or feel difficulty in holding a book or any object in hand, or immediately after holding any object in hand, it might slip from the hand and fall down on the ground, or if you observe your one hand looks weaker than the other one in shape, you then are probably suffering from carpel tunnel syndrome, and you without further delay must consult a vascular surgeon.
Do not avoid some important investigation
You yourself can also do a simple test, put your elbow on a table and let your wrist fall forward. If on bending the wrist, you feel tingling sensation and mild Pain in finger, the possibility of you suffering from carpel tunnel syndrome cannot be excluded. Two very important tests called N.C.V. (nerve conduction velocity) and E.M.G.(electromyogram) are advised, in a case of suspected diagnosis of carpel tunnel syndrome. These two tests tell us how serious is the problem and how much damage has been done to nerve & muscles of the affected hand. Besides these, ultrasound of hand also helps in assessing the pressure exerted upon nerves of the hand. X-ray of hand is also important to reveal any masked old injury or fracture of hand and swelling of joint of hand. Sometimes, MRI hand is also helpful to know any pressure on nerves exerted by an old injury of nerve or a nerve tumor.
After all what is the treatment of this problem?
First of all, one should know it is very important to take this problem seriously, because carelessness will prove costly and tormenting on later stages. If problem is mild, it can be controlled with some medication and special exercises. One should keep the hand straight up and do not allow your wrist to bend forward. To avoid bending of wrist during night, one should wear specialized splint or brace on hand, so that one can sleep peacefully during night. Sometimes painkillers do help to some extent. If you are in such a profession where you are required to keep your wrist bent-up for a longtime, or you have to bend your wrist repeatedly, you should give a serious thought to change your profession, otherwise problem will continue to deteriorate. Sometimes cortisone or steroid injection into wrist to help in relieving pain to some extent, but it is definitely not a permanent remedy.
When to think of surgery?
One should think seriously about a surgical option only when there is no let-up in pain in spite of medicine and exercise and more so if pain has been persisting throughout 24 hours and causing sleepless nights. Surgery on one hand will help in relieving pain and tingling sensation and on the other hand prevents muscles of hand getting permanently damaged. After the surgery, one can take a discharge from the hospital the very same day. In this procedure of carpel tunnel syndrome, compressive pressure on nerve is removed through surgery.
(The author is Senior Vascular and Cardio Thoracic Surgeon)
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