Carpal tunnel syndrome is caused by pressure on the median nerve. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, the symptoms can include numbness, tingling and weakness in the hand and arm.
What causes carpal tunnel syndrome?
Most cases of carpal tunnel syndrome have no specific cause, although any or all of the following may be a contributing factor:
- Frequent, repetitive, small movements with the hands (such as with typing or using a keyboard)
- Frequent, repetitive, grasping movements with the hands (such as with sports and certain physical activities)
- Joint or bone disease (for example, arthritis, osteoarthritis, or rheumatoid arthritis)
- Hormonal or metabolic changes (for example, menopause, pregnancy, or thyroid imbalance)
- Changes in blood sugar levels (may be seen with type 2 diabetes)
- Other conditions or injuries of the wrist (for example, strain, sprain, dislocation, break, or swelling and inflammation)
- Family history of carpal tunnel syndrome
What are the symptoms of carpal tunnel syndrome?
These are the most common symptoms:
- Weakness when gripping objects with one or both hands
- Pain or numbness in one or both hands
- “Pins and needles” feeling in the fingers
- Swollen feeling in the fingers
- Burning or tingling in the fingers, especially the thumb and the index and middle fingers
- Pain or numbness that is worse at night, interrupting sleep
How is carpal tunnel syndrome diagnosed?
Your provider will check your medical history and give you a physical exam. He or she may recommend that you have electrodiagnostic tests on your nerves. These tests are the best way to diagnose carpal tunnel syndrome. Electrodiagnostic tests stimulate the muscles and nerves in your hand to see how well they work.
Although it is a gradual process, for most people carpal tunnel syndrome will worsen over time without some form of treatment. For this reason, it is important to be evaluated and diagnosed by your doctor early on. In the early stages, it may be possible to slow or stop the progression of the disease.
If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved without surgery. If your diagnosis is uncertain or if your symptoms are mild, your doctor will recommend nonsurgical treatment first.
Nonsurgical treatments may include:
Bracing or splinting. Wearing a brace or splint at night will keep you from bending your wrist while you sleep. Keeping your wrist in a straight or neutral position reduces pressure on the nerve in the carpal tunnel. It may also help to wear a splint during the day when doing activities that aggravate your symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as ibuprofen and naproxen can help relieve pain and inflammation.
Activity changes. Symptoms often occur when your hand and wrist are in the same position for too long—particularly when your wrist is flexed or extended.
If your job or recreational activities aggravate your symptoms, changing or modifying these activities can help slow or stop progression of the disease. In some cases, this may involve making changes to your work site or work station.
Nerve gliding exercises. Some patients may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel. Specific exercises may be recommended by your doctor or therapist.
Steroid injections. Corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the carpal tunnel. Although these injections often relieve painful symptoms or help to calm a flare up of symptoms, their effect is sometimes only temporary. A cortisone injection may also be used by your doctor to help diagnose your carpal tunnel syndrome.
If nonsurgical treatment does not relieve your symptoms after a period of time, your doctor may recommend surgery.
The decision whether to have surgery is based on the severity of your symptoms—how much pain and numbness you are having in your hand. In long-standing cases with constant numbness and wasting of your thumb muscles, surgery may be recommended to prevent irreversible damage.
The surgical procedure performed for carpal tunnel syndrome is called a “carpal tunnel release.” There are two different surgical techniques for doing this, but the goal of both is to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. This increases the size of the tunnel and decreases pressure on the median nerve.
Immediately following surgery, you will be encouraged to elevate your hand above your heart and move your fingers to reduce swelling and prevent stiffness.
You should expect some pain, swelling, and stiffness after your procedure. Minor soreness in your palm may last for several weeks to several months.
Grip and pinch strength usually return by about 2 to 3 months after surgery. If the condition of your median nerve was poor before surgery, however, grip and pinch strength may not improve for about 6 to 12 months.
You may have to wear a splint or wrist brace for several weeks. You will, however, be allowed to use your hand for light activities, taking care to avoid significant discomfort. Driving, self-care activities, and light lifting and gripping may be permitted soon after surgery.
At Amrita Medical Center, our staff is happy to answer any of your questions and help you decide if the right fit for you. We even offer same day appointments for your convenience. Contact us here!