Carpal tunnel syndrome is one of the most common problems affecting the hand. People with this condition may experience pain, numbness, and general weakness in the hands and wrists. Lifestyle changes, such as wrist splints and environmental changes, are all possible treatments. Surgery is another option for carpal tunnel.
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a common condition that causes pain, numbness, tingling, and weakness in the hands and wrists. It occurs when there is increased pressure in the wrist, a nerve called the median nerve. This nerve provides sensation to the thumb, index and middle fingers, and half of the ring finger. The little finger ("little finger") is usually not affected.
Carpal tunnel syndrome was first described in the mid-1800s. The first carpal tunnel release surgery was performed in the 1930s. This condition has been well-recognized by plastic surgeons for over 40 years.
What is carpal tunnel?
The carpal tunnel is a narrow tube or tube in the wrist. Similar to a tunnel you can drive through, this part of the wrist allows the median nerve and tendon to connect the hand to the forearm. Parts of this tunnel include:
Carpal bones: These bones make up the bottom and sides of the tunnel. They form a semicircle.
Ligament: The top of the tunnel, the ligament is the strong tissue that holds the tunnel together.
Inside the tunnel are the median nerve and tendon.
Median nerve: This nerve provides sensation to most of the fingers on the hand (except the little finger). It also increases the strength at the base of the thumb and index finger.
Tendons: Rope-like structures, tendons connect the muscles of the forearm to the bones of the hand. They allow flexing of the fingers and thumb.
Does carpal tunnel syndrome only happen to office workers or factory workers?
Won't. Many people with carpal tunnel syndrome have never done an office job or worked on an assembly line. It affects people who use their wrists and hands repeatedly at work and play. Anyone can get carpal tunnel syndrome, but it's not common until the age of 20. The chance of developing carpal tunnel syndrome increases with age.
Who is at risk for carpal tunnel syndrome?
People at risk for carpal tunnel syndrome are those who engage in activities or jobs that involve repetitive finger use. Sports that may put people at risk for carpal tunnel syndrome include:
- long-term use.
- Extreme wrist action.
Many other factors can also contribute to the development of carpal tunnel syndrome. These factors may include:
Genetic (smaller carpal tunnels can run in families).
- Hemodialysis (the process in which blood is filtered).
- Fractured and dislocated wrist.
- Deformity of the hand or wrist.
- Arthritis diseases such as rheumatoid arthritis and gout.
- Thyroid hormone imbalance (hypothyroidism).
- A lump (tumor) in the carpal tunnel.
- Amyloid deposits (an abnormal protein).
- Carpal tunnel syndrome is also more common in women than men.
Symptoms and Causes
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome is caused when the space in the wrist (carpal tunnel) narrows. This compresses the median nerve and tendon (located in the carpal tunnel), causing them to swell, severing the feeling in the fingers and hand.
How often does carpal tunnel syndrome cause hand pain?
Although carpal tunnel syndrome is a common condition, its symptoms differ from many other sources of hand pain. There are actually several similar conditions that can cause hand pain. These include:
De Quervain tendinopathy: A condition in which swelling (inflammation) affects the wrist and the base of the thumb. In this case, you feel pain when you make a fist and simulate shaking hands with someone.
Trigger finger: This condition causes soreness at the base of the finger or thumb. Trigger fingers can also cause pain, locking (or sticking), and stiffness when flexing the fingers and thumb.
Arthritis: This is an umbrella term for many conditions that cause stiffness and swelling in the joints. Arthritis can affect many joints in your body, ranging from causing a small amount of discomfort to destroying the joints over time (osteoarthritis is a type of degenerative arthritis).
What are the symptoms of carpal tunnel syndrome?
Symptoms usually start slowly and can occur at any time. Early symptoms include:
Numbness at night.
Tingling and/or pain in the fingers (especially the thumb, index and middle fingers).
In fact, because some people sleep with their wrists bent, nighttime symptoms are common and can wake a person from sleep. These nocturnal symptoms are usually the first to be reported. Shaking hands can help relieve symptoms in the early stages of the condition.
Common daytime symptoms may include:
- The sensation at the fingertips is reduced.
Difficulty completing small tasks by hand, such as:
- Handle small objects.
- Driving while holding the steering wheel.
- Take a book and read.
- Use a computer keyboard.
As carpal tunnel syndrome worsens, symptoms become more stable. These symptoms may include:
- Weakness is in hand.
- Inability to perform tasks that require fine motor skills (such as buttoning a shirt).
- drop objects.
- In the most severe cases, the muscles at the base of the thumb shrink significantly (atrophy).
Diagnosis and Testing
How is Carpal Tunnel Syndrome Diagnosed?
First, your doctor will discuss your symptoms, medical history, and examine you. Next, run tests, which may include:
Tinel's sign: In this test, the doctor taps the median nerve in the wrist to see if it creates a tingling sensation in the finger.
Wrist flexion test (or Phalen test): In this test, the patient places the elbow on a table and allows the wrist to drop freely forward. People with carpal tunnel syndrome experience numbness and tingling in their fingers for 60 seconds. The faster the symptoms appear, the more severe the carpal tunnel syndrome.
X-rays: Wrist X-rays may be done if wrist movement is limited, or if there are signs of arthritis or trauma.
Electromyography (EMG) and nerve conduction studies: These studies determine how well the median nerve itself works and how well it controls muscle movement.
management and treatment
Carpal tunnel syndrome can be treated in two ways: non-surgical or surgical. Both methods have pros and cons. Usually, non-surgical treatments are used for less severe cases and allow you to continue your daily activities without interruption. Surgery can help more severe cases with very positive results.
- How to Treat Carpal Tunnel Syndrome Without Surgery
Non-surgical treatment is usually tried first. Treatment begins with:
Wear a wrist splint at night.
- Take an NSAID, such as ibuprofen.
- Cortisone injection.
Other treatments focus on ways to change the environment to reduce symptoms. This is common in the workplace, where you can make modifications to help with carpal tunnel. These changes may include:
Raise or lower your chair.
- Move your computer keyboard.
- Change hand/wrist position while performing activities.
- Use splints, exercises, and heat therapy recommended by your hand therapist.
Surgery is recommended when carpal tunnel syndrome does not respond to nonsurgical treatment or has become severe. The goal of surgery is to increase the size of the tunnel to reduce pressure on the nerves and tendons that pass through the space. This is done by cutting (releasing) the ligament covering the carpal tunnel at the base of the palm. This ligament is called the transverse carpal ligament.
If you have surgery, you can expect:
An outpatient procedure that leaves you awake but with local anesthesia (pain reliever). In some cases, your doctor may provide an IV (directly into a vein) anesthetic. This option allows you to take a short nap and wake up when the program is finished. This is not a general anesthesia, as is used in surgery. Instead, your medical team will monitor you during the procedure (called monitored anesthesia care, or MAC). This is also used in procedures such as colonoscopy.
Brief discomfort for about 24 to 72 hours after surgery. People usually experience complete relief of nighttime symptoms quickly—even the night after surgery.
The stitches are removed 10 to 14 days after surgery. By using a specific exercise program, the use of the hand and wrist in daily activities is gradually restored.
The affected hand is unable to perform heavier activities for about four to six weeks. Recovery time may vary depending on your age, general health, severity of carpal tunnel syndrome, and how long you have had symptoms. You will continue to gain strength and feel for the second year after surgery.
Relieve most carpal tunnel syndrome symptoms.
How to prevent carpal tunnel syndrome?
Carpal tunnel syndrome can be difficult to prevent. This condition can be caused by many different activities in a person's daily life, so prevention can be challenging. Workstation changes -- proper seating, hand and wrist placement -- can help reduce some of the factors that can contribute to carpal tunnel syndrome. Other prevention methods include:
Keep your wrists straight when you sleep.
Keep your wrist straight when using the tool.
Avoid repeatedly bending (curling) and extending your wrist.
Reduce repetitive/strong grips when the wrist is in a flexed position.
Take frequent breaks from repetitive activities.
Conditioning and stretching exercises before and after activity.
Monitor and appropriately treat medical conditions associated with carpal tunnel syndrome.