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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a common condition that causes a tingling sensation, burning, numbness and discomfort in the wrist, hand and fingers. The numbness commonly affects the thumb, index, long and ring fingers. These symptoms occur when a nerve in the wrist called the median nerve becomes pinched as it passes through the carpal tunnel located between your forearm and the palm of the hand. The structure that is pinching the nerve is called the “transverse carpal ligament”. Carpal tunnel syndrome most often affects women and the elderly.

The symptoms start gradually and worsen over time.  Symptoms typically worsen at night while sleeping, in the morning hours when you wake up, when driving a car, talking on the phone or reading a book. Any activity that causes the wrist to be bent forward or backward for long periods can aggravate the condition.

It is important to get a diagnosis and treatment to relieve the pressure on the nerve. Left untreated, the constant pressure can damage the nerve and exacerbate symptoms.

Other symptoms include pain or tingling that travels up the forearm, weakness and clumsiness which interferes with the ability to perform fine motor movements, and dropping items from the hand involuntarily.

What causes carpal tunnel syndrome?

The carpal tunnel is made of the wrist bones and ligaments and is only about one inch wide. When the tunnel becomes narrowed or the tendon swells, this creates pressure on the nerve. Narrowing of the tunnel is often caused by repetitive hand and wrist motions that cause the tendons to swell and increase pressure on the nerve.

Risk factors include smaller carpal tunnels that can run in families, hormone changes during pregnancy that can cause swelling, and other health conditions such as diabetes, rheumatoid arthritis and thyroid disease have been associated with carpal tunnel syndrome.

Diagnosis

During a physical exam, your Ortho Illinois doctor will examine your hand and wrist, perform tests like bending your wrists, and test for nerve damage and weakness at the base of the thumb.  Nerve condition studies may be used to test how well the median nerve is working. A test of the electrical activity of the muscles may be done to assess nerve and/or muscle damage. Imaging studies may be used to evaluate the nerve for signs of compression.

Treatment is designed to slow or stop progression of the condition.

Nonsurgical Treatment

Symptoms can be relieved without surgery in early cases, when there is no nerve damage.

  • Nonsurgical treatment usually includes some sort of brace or splint to keep the wrist in a neutral position to relieve pressure. It may be worn at night and during the day to prevent aggravation of symptoms.
  • Over the counter anti-inflammatory drugs can help relieve pain and inflammation.
  • Changes or modification to activities that cause pain and symptoms can help to slow or stop progression of the syndrome.
  • Steroid injections can relieve symptoms and calm flare-ups, but the effect is only temporary.
  • Physical therapy with specific exercises can help the nerve move freely.

Surgical Treatment

Carpal tunnel surgery is called “carpal tunnel release”. It is an outpatient surgery recommended for patients who have failed nonsurgical treatment. The goal of surgery is to relieve pressure on the nerve by dividing the transverse carpal ligament. Surgery will improve symptoms. But, it may take up to a year to become pain and symptom free after surgery. The good news is that a recurrence of carpal tunnel syndrome is rare after surgical correction.