Carpal tunnel syndrome is a common condition affecting the median nerve as it passes through a narrow tunnel in the wrist.
Symptoms are often worse at night or first thing in the morning. It may also become a problem when holding an object such as a phone, book or steering wheel, when your wrist is bent forwards and your fingers are in a fist position.
The anatomy of the wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome. At first, symptoms of carpal tunnel syndrome tend to be subtle or may come and go. Pain and other sensations begin gradually and worsen over time.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is when the median nerve is compressed as it passes through the carpal tunnel. The carpal tunnel is an opening in your wrist that is formed by the carpal bones on the bottom of the wrist and the transverse carpal ligament across the top of the wrist. The median nerve provides sensory and motor functions to the thumb and 3 middle fingers. If it gets compressed or irritated, you may have symptoms.
Symptoms
Carpal tunnel syndrome causes a tingling feeling or pins and needles, numbness, and sometimes pain in the hand. The symptoms can sometimes be felt in the forearm or further up your arm. It tends to come on gradually over a period of weeks.
You will usually feel it worst in the thumb, index and middle fingers, but sometimes it might feel like your whole hand is affected. You may also have an ache running up your arm to the shoulder or neck. It can affect just one or both hands.
The symptoms tend to be worse at night and can disturb your sleep, but you may also notice it when you wake up in the morning. Hanging your hand out of bed or shaking it around will often help reduce the pain and tingling.
Causes
The most likely cause of carpal tunnel syndrome is extra pressure on the median nerve at the wrist inside the tunnel. This extra pressure can come from swelling (inflammation) of the contents inside the tunnel. When pressure results in nerve symptoms, it is called compressive neuropathy.
Even making a tight closed fist or holding the wrist in bent or extended positions can put increased pressure on the median nerve. A prolonged or constant fist or bend (like a fist during sleep, reading a book, or some other activities) may put enough pressure to cause numbness/tingling.
Repetitive activities in the workplace with forceful or repetitive grips or vibration can also increase symptoms. The determination of cause of symptoms requires experienced and specialized health care providers to provide an opinion, taking many factors into account.
While symptoms can sometimes be worse at night, sleep has not been shown to cause carpal tunnel. Some people get symptoms while driving a car. This is also not necessarily the primary cause of the problem. The wrist position during driving or sleep, for example, may simply aggravate the symptoms.
Risk Factors
Although some studies have suggested that over half of CTS cases are associated with workplace factors, most studies now indicate that CTS is primarily associated with medical or physical conditions such as diabetes, osteoarthritis, hypothyroidism, acromegaly, sarcoidosis, pregnancy, and rheumatoid arthritis.
Women have a significantly higher risk for carpal tunnel syndrome than men. Older, overweight, and physically inactive people are at higher risk.
Diagnosis
Early diagnosis and treatment are important to avoid permanent damage to the median nerve.
- Physical exam. Your doctor will examine your hands, arms, shoulders, and neck to determine if your complaints are related to daily activities or to an underlying disorder and to rule out other conditions that mimic carpal tunnel syndrome. Your wrist will be checked for tenderness, swelling, warmth, and discoloration. Your fingers will be tested for sensation, along with muscles at the base of the hand for strength and signs of atrophy.
- Routine laboratory tests and X-rays can reveal fractures, arthritis, and nerve-damaging diseases such as diabetes.
- Specific wrist tests may produce the symptoms of CTS.
- In the Tinel test, the doctor taps on or presses on the median nerve in your wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs.
- The Phalen, or wrist-flexion, test involves having you hold your forearms upright by pointing the fingers down and pressing the backs of the hands together. If you have CTS, you should feel tingling or increasing numbness in your fingers within 1 minute. Your doctor may also ask you to try to make a movement that brings on symptoms.
- Electrodiagnostic tests may help confirm the diagnosis of CTSs.
- A nerve conduction study measures how quickly impulses are transmitted along a nerve. Electrodes are placed on your hand and wrist and a small electric shock is applied and the speed with which nerves transmit impulses is measured
- In electromyography, a fine needle is inserted into a muscle and electrical activity is viewed on a screen to determine the severity of damage to the median nerve.
- Diagnostic imaging also can help diagnose CTS or show problems.
- Ultrasound imaging can show an abnormal size of the median nerve.
- Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.
Treatment
Treating any carpal tunnel symptoms early on is important to ensure the best results and healing.
Nonsurgical options include:
- avoiding positions that overextend your wrist
- wrist splints that hold your hand in a neutral position, especially at night
- mild pain medication and medications to reduce inflammation
- treatment of any underlying conditions you may have, such as diabetes or arthritis
- steroid injections into your carpal tunnel area to reduce inflammation
Surgical Treatment
Carpal tunnel release is a surgery to treat carpal tunnel syndrome. Carpal tunnel syndrome is a common disorder caused by compression of the median nerve in the wrist. It can lead to pain, numbness, and sometimes disability of the hands. Carpal tunnel surgery involves relieving pressure on the median nerve by cutting part of the carpal ligament. This band of tissue holds the wrist joint together.
Carpal tunnel release is a common surgery but has risks and potential complications. Your doctor will probably recommend less invasive treatment options for carpal tunnel syndrome before considering carpal tunnel release for you. Consider getting a second opinion about all of your treatment choices before having a carpal tunnel release.
Doctors generally do not consider carpal tunnel release surgery unless less invasive treatments have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on carpal tunnel release.
Contact Ventura Orthopedic Today
Carpal tunnel syndrome is often associated with repetitive actions of the hands and wrists. Examples include long-term keyboarding, use of vibrating tools, or assembly line jobs. These actions can cause swelling and increased pressure on the median nerve over time. This can lead to pain and numbness that can become disabling.
Our team works together to design age-appropriate, individualized treatment plans that help you get back to normal life as quickly and safely as possible. If you are concerned about repetitive action related injuries, talk to the experts at Ventura Orthopedics today. Call us today at 800-698-1280 to schedule an appointment.
