Painful Disorders

There are many causes of tingling & numbness in the hand like carpal tunnel syndrome, thoracic outlet compression syndrome ,cervical rib, cubital tunnel syndrome, diabetic neuropathy, Vit B12 deficiency,alcoholic neuropathy etc. However what is the exact cause of it can be decided by your hand surgery doctor after thorough  evaluation.out of all the above mentioned cause the carpal tunnel is the most common cause of tingling & numbness in the hand.

Carpal tunnel syndrome (CTS)

is a condition of increased pressure on the median nerve at the wrist,which is more common in female sex. Symptoms may include numbness, tingling, and pain in the arm, hand, and fingers . Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the median nerve. When the pressure from the swelling becomes great enough to disturb the way the nerve functions, numbness, tingling, and pain may be felt in the hand and fingers.

Causes of carpal tunnel syndrome?

Usually the cause is unknown., but there are many causes which can cause carpal tunnel syndrome like

• Hypothyroidism.

• Diabetes.

• During pregnancy

• Renal failure.

• Tumour/mass in the area of carpal tunnel

• Tubercular synovitis of flexor tendon sheath.

• Previous malunited distal radius fracture.

• There may be a combination of causes.

Signs and symptoms of carpal tunnel syndrome

Symptoms usually include pain, numbness, tingling, or a combination of all. The numbness or tingling most often takes place in the thumb, index, middle, and ring fingers. The symptoms usually are felt during the midnight with early morning awakning .these may be noticed during daily activities such as driving or reading a newspaper,holding the telephoneetc. Patients may sometimes notice a weaker grip,clumsiness/tiredness of hand , and a tendency to drop things. In severe cases, sensation may be permanently lost and the muscles at the base of the thumb slowly shrink (thenar atrophy), causing difficulty with pinch.

Diagnosis of carpal tunnel syndrome

Thorough medical history.

Detailed clinical evaluation.

Blood investigations to R/O hypothyroidism,diabetes,rheumatoid arthritis,renal disorders etc.

Wrist & Cervical spine x- ray & detailed investigations like MRI may be needed to rule out cervical causes
EMG/NCV (NCV–nerve conduction velocities and EMG–electromyogram) may be done to confirm the diagnosis of carpal tunnel syndrome as well as to check for other possible nerve problems.

Treatment of carpal tunnel syndrome

Symptoms may often be relieved without surgery.

Identifying and treating medical conditions,. Wearing wrist splints at night may relieve the symptoms that disturbed the sleep.

Local steroid injection into the carpal tunnel  relieve the symptoms by reducing swelling around the nerve.

When symptoms are severe or do not improve , there is sensory deficit/motor power weakness, surgery may be needed .surgery is usually day care procedure & in majority of the patients relief of symptom is instantaneous.

Tennis Elbow

Tennis elbow or lateral epicondalitis is a common problem seen in day to day practice.

The patients usually complaints of pain over the lateral aspects (outer aspect) of elbow especially with activity involving wrist extension movements & lifting activity. opening a tight jar, pouring a container of liquid & lifting some objects with palm facing down is also produces pain over the outer aspect of elbow.

The causative factors include overuse or sometimes the direct blow to the elbow. however the conditions which causes other musculskelaton pain can also cause tennis elbow pain should be ruled out by thorough clinical & blood investigations. Sometimes cervical radiculopathy of C6 nerve root may mimic like tennis elbow.

Treatment

Activity modification, nonsteroidal anti inflammatory medication, brace & local steroids are the main treatment which cures the most of the patients. Rarely those who do not respond to conservative line of treatment gets benefit by surgery.

Dr shailesh Gupta ,Hand surgeon,India,MP,Indore is dealing with this problem on regular basis.