As of: January 22, 2024, 10:14 a.m
By: Natalie Hull-Deichsel
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Not only risk groups are at risk, everyday movements can also cause the typical pain.
Why those affected should see a doctor early.
Pain and sensory disturbances in the hand that originate from the thumb and are particularly noticeable at night or during exertion.
Anyone who notices such symptoms could develop what is known as carpal tunnel syndrome due to narrowed median nerves in the wrist.
In some cases, the characteristic pain that can result from inflammation can also occur in both hands.
If left untreated, there is a risk that the hand muscles will fail, which can lead to deterioration and symptoms of paralysis.
In an interview with Ippen.Media, two experts from the Ingolstadt Clinic explain why you should go to the doctor at the first suspicion and what therapeutic options are available.
Wrist pain: What those affected should pay attention to
Pain and loss of sensation in the ball of the thumb can indicate a painful pinching of the nerves in the carpal tunnel of the wrist.
© Tharakorn/Imago
Physically demanding jobs in particular, with many, recurring and manual movements as well as bending and stretching of the hands in the wrist, lead to repeated strain and thus possible constriction of the median nerves, which subsequently swell.
Working on hand-held, vibrating machines such as saws or masonry drills also increases the risk of pinched nerves and, consequently, carpal tunnel syndrome.
In the advanced stage, there is a persistent tingling sensation in the area of the thumb, index, middle finger and ring finger and there is muscle loss in the ball of the thumb (thenar atrophy).
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Everyday mechanical influences, such as cycling, can also trigger or worsen the symptoms.
“If you or your family doctor suspects carpal tunnel syndrome, we recommend seeing a specialist to clarify the cause of your symptoms,” recommends Prof. Dr.
Hans-Georg Palm, director of the Center for Orthopedics and Trauma Surgery at the Ingolstadt Clinic and expert in the field of muscle, bone and joint diseases such as osteoarthritis.
Pain from carpal tunnel syndrome: how to make the diagnosis
Carpal tunnel syndrome is detected and diagnosed through a clinical examination with special tests (so-called Hoffmann-Tinel sign and Phalen test) and usually by a (hand) surgeon.
In addition, a neurological examination should be carried out in which the nerve conduction velocity and the electrical voltage in the muscle (electromyogram) are measured - if possible on both arms, in order to confirm the diagnosis of carpal tunnel syndrome.
“This makes it possible to objectively determine whether and to what extent there is narrowing of the median nerve,” says hand surgeon Dr.
Gudrun Schlewitz from her experience in daily practice.
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Dr.
Gudrun Schlewitz, hand and plastic surgeon at the Ingolstadt Clinic, specializes in, among other things, the treatment of carpal tunnel syndrome.
© Klinikum Ingolstadt/Gudrun Schlewitz
An ultrasound examination of the nerve can provide additional information about the cause in order to rule out other possible diseases, such as a cyst (ganglion) or inflammation of the flexor tendons.
Since 2009, carpal tunnel syndrome has been recognized as an occupational disease in certain professions.
Dr.
Gudrun Schlewitz, hand and plastic surgeon at the Ingolstadt Clinic
Treating carpal tunnel syndrome: initial treatment options for pain and inflammation
Especially in the early stages and neurologically not yet advanced carpal tunnel syndrome or with mild symptoms, a wrist splint (median splint) for nighttime positioning, which relieves the pressure on the median nerve, can reduce the symptoms.
Sometimes it is useful and necessary to take a decongestant, anti-inflammatory medication with the active ingredient ibuprofen or diclofenac at the same time.
Physiotherapy with special stretching exercises can provide additional relief to the nerve and, in some cases, make the patient pain-free again.
Carpal tunnel syndrome: exercises for treatment at home
Some sufferers with persistent pain in the hand and forearm have good experiences with physiotherapy exercises.
In the case of acute symptoms, injecting cortisone can lead to a decrease in irritation and swelling of the nerve and flexor tendons.
However, this usually only helps for a few weeks.
Therapy for carpal tunnel syndrome: which patient should possibly undergo surgery?
If conservative measures such as immobilization and anti-inflammatory medications have been exhausted or if there is neurologically advanced carpal tunnel syndrome, surgical treatment should be considered, says Dr.
Schlewitz.
“If the symptoms have existed for a long time, in particular a significant decline in the ball of the thumb muscles, with long-term narrowing of the median nerve, the nerve may no longer recover completely or the fingertips may remain tingling,” says the experienced hand surgeon from her practice patients.
Two surgical techniques to treat carpal tunnel syndrome
The most common operation is the so-called open carpal roof split, which usually takes ten to 15 minutes.
A two to two and a half centimeter long incision is made in the skin and, under local anesthesia, the connective tissue ligament (retinaculum musculorum flexorum manus) - which forms the roof of the carpal tunnel - is severed in the hand using the finest tools.
In this way, the median nerve can be freed from constriction.
A method that is used much less frequently in Germany is the endoscopic (minimally invasive) carpal roof splitting.
However, the risk of nerve injury is increased because the reduced visibility for the surgeon can lead to incomplete separation of the retinaculum musculorum flexorum manus.
Carpal tunnel syndrome therapy: Can the hand be moved again immediately after the operation?
Even though patients should wear a wrist splint for protection and immobilization for about a week after the operation, it is important to move the wrist and fingers several times a day to avoid scarring.
It can take six to eight weeks for the hand to be fully resilient again.
The scar can be particularly sensitive for three to four months.
Treating carpal tunnel syndrome: at best, surgery can cure the disease
“The nighttime pain usually improves or completely disappears immediately after the operation,” explains Dr.
Gudrun Schlewitz continues the conversation.
However, discomfort such as tingling can persist for several months after the operation.
If carpal tunnel syndrome has existed for a long time and for years, the median nerve may no longer recover despite surgical relief and tingling sensations may remain.
Complications such as bruising or injury to the thumb nerve are very rare.
This article only contains general information on the respective health topic and is therefore not intended for self-diagnosis, treatment or medication. It in no way replaces a visit to the doctor. Our editorial team is not allowed to answer individual questions about medical conditions.