CARPAL TUNNEL SYNDROME IN WOMEN, SYMPTOMS & TREATMENTS

Dr. Nguyen Viet Thinh, 1^st- degree orthopedist - Deputy Head of the General Surgery Department at AIH stated that carpal tunnel syndrome is very common and often occurs in women aged 40 to 59 years.

Carpal tunnel syndrome is a condition where the median nerve is compressed within the carpal tunnel, manifested by pain, tingling, numbness, and itching in the index finger, middle finger, and ring finger, which may gradually radiate up the forearm towards the shoulder accompanied by muscle pain and cramps.

In general, carpal tunnel syndrome can occur at mild and severe levels. Symptoms of carpal tunnel syndrome include pain in the hand and wrist accompanied by feelings of numbness and tingling in the area supplied by the median nerve (the palm region of the thumb, index finger, middle finger, and half of the radial side of the ring finger), but in some cases may involve the entire hand. As the condition progresses to a severe stage, patients may experience sharp or burning pain along with numbness and tingling; they may need to massage their hands to relieve pain and restore sensation. Myoatrophy and myasthenia in opposition and thumb abduction may appear later.

Why is carpal tunnel syndrome more common in women?  
Most cases of carpal tunnel syndrome have no clearly identified cause. However, it has been noted that women are three times more likely to develop carpal tunnel syndrome than men. Some reasons explain why women are at a higher risk for this syndrome:

• Anatomy of women’s hands: The carpal tunnel in women is often narrower than in men, limiting the space for the median nerve and other structures within the carpal tunnel. This increases the likelihood of nerve compression.

• Pregnancy: Hormonal changes during pregnancy can cause swelling and inflammation of the components inside the carpal tunnel.

• Related medical conditions: Obesity, diabetes, rheumatoid arthritis, kidney failure, and thyroid dysfunction are diseases associated with carpal tunnel syndrome.

Some other causes of carpal tunnel syndrome include:

• Genetic factors: Family members with small carpal tunnels or special anatomical structures may increase the risk of developing carpal tunnel syndrome.

• Wrist injuries: Injuries such as dislocations or fractures can alter the structure and space within the carpal tunnel.

• Rheumatoid arthritis and inflammatory diseases: Conditions that cause inflammation can affect the lining around the wrist tendons, increasing the risk of compressing the median nerve.

• Post-inflammatory or post-traumatic injuries: Arthritis, ligament injuries, polyneuropathy, or wrist injuries can change the space within the carpal tunnel, putting pressure on the nerve.

• Repetitive hand use: Jobs that require repetitive motions of the hands and wrists in a long period of time (for example: typing, sewing, office work) can cause tendon damage, inflammation, and nerve compression. Middle-aged women, especially those engaged in such work, are at higher risk of developing carpal tunnel syndrome.  

Diagnosis and treatment of carpal tunnel syndrome

► Diagnosis of carpal tunnel syndrome

• The doctor will ask about symptoms such as numbness, pain, or muscle weakness in the arms, especially in the thumbs, index fingers, and middle fingers. These symptoms often worsen at night.

• Tinel’s Test: Diagnosis of carpal tunnel syndrome is often based on the Tinel sign, where paraesthetic symptoms of the median nerve are triggered by tapping over the location of the median nerve in the carpal tunnel on the palmar side of the wrist.

• Phalen’s Test: The patient is asked to flex their wrist for 60 seconds; if symptoms of tingling and numbness in the fingers appear more quickly, carpal tunnel syndrome is more severe.

• X-ray of the wrist: To determine whether carpal tunnel syndrome is caused by arthritis or injury.

• Electromyography (EMG) and nerve conduction studies: These tests assess the activity of nerves and muscles, helping to determine the extent of compression on the median nerve.

• Ultrasound or MRI: Sometimes, a doctor may request an ultrasound or MRI to examine the structure of the wrist and rule out other causes of pain.  
   

► Treatment of carpal tunnel syndrome  
Dr. Nguyen Viet Thinh, 1^st-degree orthopedist stated that the treatment for carpal tunnel syndrome may include conservative methods or surgery, depending on the severity of the condition and the patient’s response to initial treatment methods.  

1. Conservative treatment  

• Wrist splinting: Wearing a wrist splint helps maintain the wrist in a neutral position (not bent or flexed), thereby reducing pressure on the median nerve.

• Pain relievers and Anti-inflammatories: Certain medications may be prescribed to help alleviate pain in the carpal tunnel for a short period, such as paracetamol or ibuprofen. It is important to adhere strictly to the specialist’s instructions to avoid dangerous side effects on health.

• Steroid injections: Injecting cortisone into the carpal tunnel area is a common treatment method for reducing inflammation, pain, and swelling associated with carpal tunnel syndrome. Some patients may experience early pain relief after the injection, while others may have delayed relief, and some may not experience any improvement at all. Before administering the injection, the doctor will advise the patient about recommendations and potential risks of complications associated with these injection methods. If cortisone injections do not provide long-term relief, the doctor will consider other alternative treatment options to address the issue more comprehensively.

• Physical therapy: Physical therapy helps improve flexibility and reduce tension in the muscles, tendons, and ligaments in the wrist area. Exercises can help alleviate pain, enhance ability of movement, and prevent further injury.

2. Surgical treatment  
If conservative treatment measures are applied but symptoms persist or recur, or if weakness and atrophy of the hand muscles appear, surgical decompression should be considered using either open surgery or video-assisted surgery.

The surgery primarily involves cutting the transverse carpal ligament, which helps to increase the size of the space within the carpal tunnel, thereby relieving pressure on the median nerve and flexor tendons.  
 

Effective prevention of carpal tunnel syndrome  

Carpal tunnel syndrome is commonly encountered in clinical practice. To prevent the condition, we need to pay attention to:

• Adjusting work posture: Keep the wrist in a neutral position and take regular breaks.

• Exercising: Perform stretching exercises and strengthen the arm muscles.

• Using supportive tools: Wear wrist braces and use ergonomic keyboards and mice.

• Reducing repetitive work: Break tasks into smaller parts and vary hand movements.

• Maintaining a healthy weight: Being overweight can increase pressure on the wrists, so maintaining a healthy weight is crucial.

• Managing underlying conditions such as diabetes and arthritis.

Simultaneously, if signs of carpal tunnel syndrome are detected, patients need to visit a medical facility for timely examination and treatment, which helps prevent complications such as muscle atrophy, long-term nerve damage, and improves the functional recovery of the hand.

To have an examination and treatment with Dr. Nguyen Viet Thinh, kindly make an online appoinment through the website https://aih.com.vn/en/doctor/en-nguyen-viet-thinh-dror contact the hotline (028) 3910 9999.