Root causes of carpal tunnel and trigger finger syndromes

KUALA LUMPUR: Daily repetitive routines and motions, such as using a computer keyboard and mouse, scrolling phone screens, occupational use of vibrating tools or even housework can contribute to hidden health risks that can deteriorate over time. 

These activities can lead to conditions such as carpal tunnel syndrome that can affect anyone, regardless of age. Thus, it is important to tackle its root cause so we can be more aware of how such day to day activities can create such an impact.

The condition occurs when the median nerve, located in the carpal tunnel (a narrow passageway running from the forearm to the palm of the hand) becomes compressed. Common symptoms of this syndrome include weakness when gripping objects, along with pain, numbness, or tingling sensations. 

While there are several contributing factors to its development, it is often triggered by the repetitive movements we regularly perform with our hands.

Sunway Medical Centre Velocity (SMCV) Consultant Orthopaedic, Trauma and Sports Surgeon Dr Raymond Yeah said this epidemiological observation highlights the association between carpal tunnel syndrome and daily activities, but that it merely scratches the surface. 

“Other factors such as joint or bone diseases, hormonal or metabolic changes and fluctuations in blood sugar levels can contribute to the development of carpal tunnel syndrome as well. 

“Inflammatory arthritis can cause the protective sheath around multiple tendons in the wrist’s carpal tunnel to thicken which then reduces the already limited space in the carpal tunnel, putting pressure on the median nerve.  

“Moreover, diabetes too can cause neuropathy, which means even a slight narrowing of the carpal tunnel can have a significant impact on diabetic patients, leading to symptomatic carpal tunnel syndrome,” Dr Yeah adds. 

Are women more susceptible?

While individuals who have experienced previous wrist injuries, sprains, dislocations, or inflammation are more prone to developing carpal tunnel syndrome, it is interesting to note that this condition tends to affect women more than men – with pregnancy being a significant contributing factor. 

SMCV Consultant Orthopaedic, Trauma and Paediatric Orthopaedic Surgeon Dr Maria Wong highlights that while approximately 4% of adults of the general population are affected by carpal tunnel syndrome, the prevalence of symptoms among pregnant women is estimated between 31% to 62%.

“During pregnancy, women experience a doubling of their blood volume. As a result, the additional fluid exerts increased pressure, leading to swelling in the blood vessels throughout their body.

Consequently, in confined areas like the carpal tunnel region of the wrist, this swelling can compress the median nerve, resulting in carpal tunnel syndrome,” shares Dr Wong. 

Fortunately, after giving birth, symptoms of carpal tunnel syndrome typically subside, as the fluid levels return to normal and alleviate the extra pressure on the blood vessels. 

Nonetheless, it is advisable for pregnant mothers to consult a doctor if they experience carpal tunnel like symptoms in their hands.

Seeking medical guidance allows for a better understanding and assessment of the condition, providing mothers with peace of mind during their already challenging pregnancy journey.

Trigger finger and carpal tunnel syndrome

Similarly, individuals who experience carpal tunnel syndrome may face another prevalent non-traumatic disorder known as trigger finger. Scientifically referred to as stenosing tenosynovitis of the flexor tendons, trigger finger presents as a digit or digits that become stuck, causing pain and tightness. 

Dr Wong describes it as a clicking or catching sensation when opening and closing the fingers, which can be uncomfortable. 

She said one of the main causes of trigger finger is repetitive actions such as twisting, squeezing, grasping, or forceful hand activities. 

Additionally, medical conditions such as diabetes and rheumatoid arthritis can potentially contribute to its development as well. Similar to carpal tunnel syndrome, pregnant women are also vulnerable to trigger finger due to fluid retention and swelling during pregnancy. 

Lastly, trigger finger is more commonly observed in older individuals and is rare in children. However, Dr Wong said there is a rare condition called congenital trigger thumb that can cause locked flexion in an infant’s thumb.

Apart from the elderly, another vulnerable group prone to trigger finger is housewives. The repetitive gripping and grasping of kitchen utensils and tools could contribute to this condition. It can affect anyone engaged in activities involving repetitive finger flexion and extension. This also includes sewing, knitting, and hand-washing clothes.  

Dr Wong said individuals with jobs or hobbies that involve repetitive hand work, typing-intensive tasks, or prolonged gripping are also at a high risk of developing trigger finger. Nevertheless, there are preventive measures and treatment options available.

Reducing the risk and available treatment options

To prevent carpal tunnel syndrome and trigger finger, Dr Yeah  suggests reducing unnecessary repetitive hand motions, such as limiting leisurely use of a mobile phone and taking breaks to rest. 

He said gentle stretching exercises during resting periods can decrease stiffness and improve the affected area’s range of motion. 

Treatment options are tailored to each individual case, the first of which is splinting and this involves using a neutral wrist splint with a metal bar that restricts wrist movement while allowing finger movement. By providing the median nerve with a break, splinting can help reduce swelling and facilitate the healing of mild to moderate nerve damage. 

The splint can be worn during sleep and as frequently as possible throughout the day.

Another treatment approach is through physiotherapy, which involves exercises to improve wrist and finger range of motion and strengthen the affected area. 

Lastly, medication can be considered. Pain relief injections containing a combination of steroids and a local anaesthetic injected around the median nerve may benefit some patients. 

Dr Yeah, however, stresses that prescribing steroids during pregnancy is avoided to prevent side effects.

For mothers, Dr Wong advises that they should remain vigilant about their wrist health even after giving birth. 

The frequent lifting of the baby and repetitive motions can potentially contribute to tendinopathies caused by overuse. Therefore, it is important to be aware and take precautions to prevent any strain or injury post-delivery.

In conclusion, carpal tunnel syndrome is not confined to old age or a single cause. It can affect all age groups and is often influenced by our daily habits. 

By creating awareness of repetitive hand movements risks, we can take proactive measures to prevent and effectively manage conditions such as carpal tunnel syndrome and trigger finger.

Sunway Medical Centre Velocity is located at Lingkaran SV, Sunway Velocity. 

For enquiries, call +603 9772 9191 or email smcv-enquiry@sunway.com.my. 

For more information on Sunway Medical Centre Velocity, visit www.sunmedvelocity.com.my (Facebook: Sunway Medical Velocity).