Carpal Tunnel Syndrome

This condition occurs when there is compression of the median nerve as it passes into the hand. The median nerve can be found on the palm side of your hand (carpal tunnel). The median nerve provides sensation to your thumb, index finger, long finger and part of the ring finger. It supplies the impulse to the muscle going to the thumb. This syndrome can occur in one or both of your hands.

Swelling in your wrist can cause the compression in carpal tunnel syndrome and can lead to numbness, weakness and tingling on the side of your hand near the thumb. The pain experienced in your carpal tunnel is due to excess pressure in your wrist and on the median nerve. Inflammation can also cause swelling.

What causes carpal tunnel syndrome?

The most common cause is an underlying medical condition that causes swelling in the wrist and sometimes obstructed blood flow. Some of the most frequent conditions linked with this syndrome are:

• Diabetes
• Thyroid dysfunction
• Fluid retention from pregnancy or menopause
• High blood pressure
• Autoimmune disorders such as rheumatoid arthritis
• Fractures or trauma to the wrist

This syndrome can also be made worse if the wrist is overextended repeatedly. Repeated motion contributes to swelling and compression of the median nerve. This may be the result of:

• Poor positioning of your wrists while using your keyboard or mouse
• Prolonged exposure to vibrations from using handtools or power tools
• Repeated movement that overextends your wrist (such as playing the piano or typing)

Who is at risk for carpal tunnel syndrome?

Women are 3 times more likely to develop this syndrome than men. It is the most frequently diagnosed syndrome between the ages of 30 and 60. Some conditions such as diabetes, high blood pressure and arthritis increases the risk of developing this syndrome.

Lifestyle factors that may increase the risk include smoking, high salt intake, sedentary lifestyle and a high body mass index.

Some jobs that involve repetitive wrist movement include:

• Manufacturing
• Assembly line work
• Keyboarding occupations
• Construction work

People with these occupations may be at higher risk of developing carpal tunnel syndrome.

How can I prevent carpal tunnel syndrome?

Make lifestyle changes that reduce your risk factors for developing it.

Treat conditions such as diabetes, high blood pressure and arthritis can help to reduce your risk for developing carpal tunnel syndrome.

Pay careful attention to hand posture and avoiding activities that overextend your wrist are also important strategies. Physical therapy exercises may be helpful as well.

SYMPTOMS OF CARPAL TUNNEL SYNDROME

The symptoms usually start gradually. Common carpal tunnel syndrome symptoms include:

• Tingling or numbness: Fingers or hand may feel tingly or numb. Normally the thumb and index, middle or ring fingers are affected but not your little finger. There is sometimes a sensation like an electric shock in these fingers. It may travel from your wrist up your arm. They are often experienced while holding a steering wheel, phone or newspaper. It may wake you up from sleep. Many people “shake out” their hands in an attempt to relieve their symptoms. Over time, the numb feeling may become constant.
• Weakness: Weakness may be experienced in your hand and you may have a tendency to drop objects. This could be caused by the numbness in your hand or weakness of the thumb’s pinching muscles which are also controlled by the median nerve.

TREATMENT OPTIONS AVAILABLE FOR CARPAL TUNNEL SYNDROME

It’s essential to treat carpal tunnel syndrome as early as possible after symptoms start to show.

Some self-treatment methods include having more frequent breaks to rest your hands, avoiding activities that worsen symptoms and applying cold packs to reduce swelling may also help.

Other treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help only if you’ve experienced mild to moderate symptoms for less than 10 months.

Nonsurgical therapy

Nonsurgical methods may help improve carpal tunnel syndrome if diagnosed early. They include:

• Wrist splinting: While you sleep, a splint is used to hold your wrist still. It can help relieve nighttime symptoms of tingling and numbness. If you’re pregnant, nighttime splinting may be a good option.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen (Advil, Motrin IB, others) can help relieve pain in the short term. However, there isn’t evidence that these drugs improve carpal tunnel syndrome.
• Corticosteroids: Corticosteroid injections such as cortisone may be used to relieve pain. Your doctor may sometimes use an ultrasound to guide these injections. Corticosteroids decrease inflammation and swelling that relieves pressure on the median nerve. Oral corticosteroids aren’t considered as effective as corticosteroid injections.

If carpal tunnel syndrome is caused by rheumatoid arthritis or another type of inflammatory arthritis then treating the arthritis may reduce symptoms of carpal tunnel syndrome. However, there is no evidence.

Surgery

If your symptoms are severe or don’t respond to other treatments then surgery may be appropriate. The goal is to relieve pressure by cutting the ligament that’s pressing on the median nerve.

The surgery may be performed with 2 different techniques:

• Endoscopic surgery: A telescope-like device with a tiny camera attached to it is used to see inside your carpal tunnel. The ligament is cut through small incisions in your hand or wrist. This technique may be less painful than open surgery in the first few days or weeks after surgery.



• Open surgery: An incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.

Surgery risks may include:

• Incomplete release of the ligament
• Wound infections
• Scar formation
• Nerve or vascular injuries

The ligament tissues gradually grow back together while allowing more room for the nerve during the healing process after the surgery. This internal healing process typically takes a few months but the skin heals in a few weeks.

DIAGNOSING CARPAL TUNNEL SYNDROME

• History of symptoms: The pattern of your symptoms will be reviewed. For instance, because the median nerve doesn’t provide sensation to your little finger, symptoms in that finger may indicate a problem besides carpal tunnel syndrome.

Carpal tunnel syndrome symptoms that normally occur include tingling or numbing sensation while holding a phone or a newspaper, gripping a steering wheel or waking up during the night.

• Physical examination: The feeling in your fingers and the strength of the muscles in your hand will be tested. Bending the wrist, tapping on the nerve or simply pressing on the nerve may trigger symptoms in many people.
• X-ray: An X-ray of the affected wrist to exclude other causes of wrist pain such as arthritis or a fracture may sometimes be recommended.
• Electromyogram: The tiny electrical discharges produced in muscles is measured in this test. A thin-needle electrode is inserted into specific muscles to evaluate the electrical activity when muscles contract and rest. It can identify muscle damage and may also rule out other conditions.
• Nerve conduction study: In a variation of electromyography, 2 electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed. This test may be used for diagnosis and to rule out other conditions.
• MRI: To detect the swelling of the median nerve, narrowing of the carpal tunnel or problems with circulation of blood.
• Blood tests: Sometimes done to check for a thyroid problem, rheumatoid arthritis or another medical problem.