Carpal tunnel syndrome - tingling in the hands

Carpal tunnel syndrome is a result of compression of the median nerve in the carpal tunnel at the wrist. This nerve pressure injury causes a variety of symptoms, including hand tingling. The most common symptoms include pain, sensory disturbances such as tingling and numbness as well as a weakening of the hand and finger strength. In many cases, the symptoms can be alleviated with targeted exercises.

Carpal tunnel syndrome at a glance

Compact & concise

The carpal tunnel, also known as the carpal canal, is located on the inside of the wrist and is formed by the carpal bones and a tight ligament, the flexor retinaculum. It serves as a passageway for the median nerve and the flexor tendons of the hand.

Carpal tunnel syndrome (also known as carpal tunnel syndrome or CTS) occurs when the median nerve is pinched at the wrist. This often leads to pain, tingling in the hands, sensory disturbances, numbness, loss of strength and muscle wasting in the hand and fingers.

Carpal tunnel syndrome has been a recognized occupational disease since 2015.

Do you suffer from your fingers falling asleep at night or do you have difficulty holding a cup? From the first signs to the advanced stages of carpal tunnel syndrome, you can find out more in the next section "Symptoms of carpal tunnel syndrome".

Definition of carpal tunnel syndrome

In carpal tunnel syndrome, the median nerve in the wrist area is constricted or damaged. This nerve supplies various areas of the hand and can cause tingling, numbness, discomfort, finger pain, swelling, dysfunction or even paralysis if damaged. Here we provide an overview of the anatomical structures in the wrist area where the carpal tunnel, the tendons and the nerve run.

Interesting to know: Carpal tunnel syndrome has been recognized as an occupational disease since 2015 and is defined as follows:

"Pressure damage to the median nerve in the carpal tunnel (carpal tunnel syndrome) caused by repetitive manual activities involving flexion and extension of the wrists, increased force exerted by the hand or hand-arm vibrations." 1)

Between 3 and 10 percent of the German population suffer from this type of nerve entrapment. It mainly occurs between the ages of 40 and 70, with women being significantly more frequently affected.

The importance of the carpal tunnel in hand tingling

Carpal tunnel syndrome is often abbreviated as KTS or "C", i.e. carpal tunnel syndrome or CTS. The carpal tunnel is the connecting pathway between the forearm and hand and is bounded by the carpal bones.

The carpal tunnel is created by the carpal bones on the inside and the carpal ligament (retinaculum flexorum), a firm band of connective tissue that lies over the bones. At the level of the wrist, it runs across the carpal canal to protect tendons and nerves. The carpal ligament ensures that these structures remain in place.

The median nerve runs from the shoulder to the fingers, where it controls muscle movements and the sense of touch. Together with nine flexor tendons, it passes through the carpal tunnel. The finger flexor tendons are surrounded by tendon sheaths that can absorb fluid and swell. Tendon sheaths are sheaths filled with synovial fluid around the tendons.

The carpal tunnel is a naturally narrow area that is extremely susceptible to overloading, pressure damage and neurological injuries.

However, the carpal tunnel itself is not rigid. The carpal bones, which together with the carpal ligament form the canal, are also not rigid. Different hand movements change the depth of the carpal tunnel.

The carpal ligament, which runs over the carpal tunnel at the wrist, forms a kind of cover and ensures that there is different amounts of space in the carpal tunnel depending on the hand movement.

What causes carpal tunnel syndrome?

Carpal tunnel syndrome occurs when the middle arm nerve is constantly irritated or damaged by repeated wrist movements, bending or stretching. However, the space in the carpal tunnel can also increase for other reasons, such as water retention due to diabetes, hormonal changes, inflammation in rheumatic diseases or after fractures near the wrist that lead to the formation of callus (scar tissue formed by bone).

Symptoms of carpal tunnel syndrome

Overview:

Early symptoms often occur at night and in the morning
Neurological complaints: Sensory disturbances such as tingling or falling asleep. Temporary numbness of the fingers is also possible.
There may also be finger pain in the thumb, index finger, middle finger and on the thumb side of the ring finger.
Shaking out the hands and cold water are often helpful.

As the disease progresses, the following symptoms may occur later:

Sensory disturbances and pain in the hands
Limited sense of touch and apparent clumsiness
Paralysis: Loss of sensitivity in the palm and fingers and severe numbness
Loss of strength and, in extreme cases, muscle atrophy in the ball of the thumb
Loss of fine motor skills in the fingers, especially on the thumb side of the hand
Muscle atrophy is particularly noticeable with hand strain

Do you belong to the risk group for carpal tunnel syndrome due to your occupation? Find out in the section on the causes!

The symptoms of carpal tunnel syndrome often start at night and later worsen during the day.

Early symptoms of carpal tunnel syndrome (initial stage)

Most people affected by carpal tunnel syndrome report that their hand initially falls asleep at night or early in the morning. The feeling often disappears by shaking out the hands. Repositioning the hand at night can also alleviate the pain at first. Some sufferers experience relief by holding their hand under cold water.

The pain can occur in the thumb, index finger, middle finger and on the thumb side of the ring finger.

If the little finger and ring finger in particular are affected, it could also be the related cubital tunnel syndrome.

Late-stage symptoms of carpal tunnel syndrome

Neurological symptoms caused by tingling hands usually begin on the palms of the hands. Later on, the discomfort gradually spreads to several fingers, including the thumb and index finger. As the median nerve runs to the shoulder, severe shoulder pain can also occur. Everyday activities such as telephoning, reading the newspaper or cycling often become increasingly difficult for those affected.

Permanent numbness in the hands leads to loss of dexterity. Many notice this during manual activities or when pressing buttons. In extreme cases, the damage to the median nerve is so severe that the muscle of the ball of the thumb, which is supplied by this nerve, continues to regress.

Those affected may have difficulty holding a cup from an early age. Due to weakness, loss of sense of touch, limited fine motor skills, sensitivity and muscle atrophy (due to atrophy), objects such as cups slip out of the hand unintentionally.

Causes and diagnosis of carpal tunnel syndrome

Overview:

Excessive tension in muscles, tendons and fascia can lead to tissue swelling and thus to pressure in the carpal tunnel.
Inflammation and fluid accumulation increase the pressure and cause sensitivity to touch

Excessive tension is caused by one-sided movement patterns:

constant flexion and extension of the hands in the wrist,
frequent forceful gripping or
hand and arm vibrations, e.g. from operating machines such as power saws.

Carpal tunnel syndrome - tingling in the hands - 6 tests to do at home

Excessive muscle tension as a cause

Carpal tunnel syndrome is caused by increasing tissue pressure and overloading the carpal tunnel.

One-sided movements, such as when working at a keyboard, lead to shortening of the hand flexor tendons. This causes high muscular-fascial tension, which leads to swelling of the tendons - the tunnel becomes narrow. The extent of the damage to the median nerve is determined by the duration and strength of the pressure in the carpal tunnel.

The blood circulation deteriorates due to this pressure, which makes the vessels more permeable. Components of the blood, including immune cells to combat the pressure, leak out more. This increased permeability increases the risk of local inflammation and fluid accumulation in the nerve, which in turn worsens blood flow.

The pain and discomfort intensify in the hands and wrists. In the long term, this can lead to nerve damage.

Rarely, fractures and injuries to the wrist can cause carpal tunnel syndrome.

Carpal tunnel syndrome: why does the pressure on tendons and nerves increase?

The pressure in the carpal tunnel increases due to a disproportion between the width of the tunnel and its contents (tendons and nerves).

Certain risk factors cause the tendons and nerves in the carpal tunnel to swell. These include

repetitive wrist movements with flexion and extension,
increased force exerted by the hands, e.g. through forceful gripping,
as well as the effect of hand-arm vibrations, e.g. from vibrating machines such as power saws or drills, which lead to overloading.

The tests for examining a possible carpal tunnel syndrome in comparison are:

1. Phalen's test: In this test, you press the backs of your hands together horizontally for 60 seconds. A positive result is indicated by unusual sensations such as numbness or pain in the wrist area after the time has elapsed.

2. reverse Phalen test: In this test, the palms of the hands are pressed together for 60 seconds. Compared to the Phalen test, this method is less reliable.

3 Hoffmann-Tinel sign: The area of the wrist where the median nerve runs is tapped while the wrists are initially left in a neutral position. The occurrence of pain or sensory disturbances is considered an indicator of carpal tunnel syndrome.

4. Carpal compression test: The hands are in a neutral position while the examiner presses on the median nerve in the area of the carpal tunnel. A positive result indicates that symptoms of carpal tunnel syndrome are triggered or intensified.

5. flexion-compression test: Your arms are stretched out on a surface with the palms facing upwards. The doctor or therapist bends the wrist upwards by 60 degrees and applies pressure to the median nerve in the carpal tunnel area. A positive result is indicated by the occurrence of discomfort.

6. tourniquet test: In this test, a blood pressure cuff is placed around your upper arm and inflated above your systolic blood pressure value. If you suffer from carpal tunnel syndrome, you may experience sensory disturbances, discomfort and pain in the area of the median nerve in the wrist.

Treatment

The most promising treatment alternative is the use of Curpal®. This patented medical device offers a non-surgical solution for carpal tunnel syndrome. By applying mechanical pressure to the back of the hand, Curpal® stretches the carpal ligament on the inside of the hand, which runs transversely from the ball of the hand to the edge of the hand.

This widens the carpal tunnel and gives the nerve more space. The pressure that led to pain and discomfort is relieved. The use of Curpal® is an effective method of preventing the progression of carpal tunnel syndrome. However, there are also other preventative measures that patients can take. These include regular wrist stretching to improve the flexibility of hand and finger movements. Wearing special wrist supports can also help to reduce pressure on the median nerve in the carpal tunnel.

Curpal® offers an innovative and gentle alternative to conventional treatment for carpal tunnel syndrome. It enables patients to alleviate their symptoms and improve their quality of life without having to undergo surgery. More information about Curpal® and its application can be found on the official website: https://www.curpal.de/.