Carpal Tunnel Syndrome

One of the most common conditions that affect the hand is carpal tunnel syndrome. People who've developed this condition often experience weakness in the hand and wrist, pain, and numbness. Treatments for carpal tunnel syndrome include conservative approaches, such as lifestyle adjustments, and surgical intervention.

What is Carpal Tunnel Syndrome?

The carpal tunnel is a narrow tube in the wrist that allows the median nerve and tendons to connect to the hand and forearm. There are two main parts of the tunnel:

Ligament: the top of the tunnel is a strong ligament that holds the tunnel together
Carpal bones: the bones that make up the bottom and sides of the tunnel, they form a semi-circle.

Within the tunnel are the median nerve and tendons. The median nerve is what provides feeling to most of the fingers in the hand, the pinky finger being the exception, and gives greater strength to the base of the thumb and index finger. The tendons in the carpal tunnel are rope-like and connect muscles in the forearm to the bones in the hand, allowing the fingers and thumb to bend.

Carpal tunnel syndrome occurs when there is increased pressure within the wrist on the median nerve, creating pain, numbness, weakness, and tingling sensations.

Symptoms

Carpal tunnel syndrome symptoms begin slowly and develop over time. The earliest symptoms of the condition include numbness at night and tingling or pain in the fingers, especially the thumb and index finger. These are often the first symptoms reported because they can wake a person when sleeping. Other symptoms of carpal tunnel syndrome include:

decreased feeling in the fingertips
tingling in the fingers
difficulty using the affected hand for things like writing, using a keyboard, holding a book handling small objects
hand weakness
dropping objects
inability to perform delicate motion tasks, such as buttoning a shirt

Risk Factors and Causes of Carpal Tunnel Syndrome

The specific cause is when the space in the carpal tunnel narrows, pressing down on the median nerve and tendons within it. The pressure makes the nerve and tendons swell, cutting off sensation to the fingers and hand. There are risk factors and other causes of carpal tunnel syndrome:

Extreme wrist motions
Vibration on the wrist
Long-term use
Heredity
A wrist fracture and/or dislocation
Hand or wrist deformity
Arthritic diseases like gout or rheumatoid arthritis
Diabetes
Alcoholism
Tumor in the carpal tunnel
Amyloid deposits

Diagnosing Carpal Tunnel

To diagnose carpal tunnel syndrome, a healthcare provider will discuss the symptoms a patient is experiencing, and their medical history and perform some tests, such as:

X-rays of the wrist if there is a limited range of motion
EMG to determine how well the median nerve is working

Wrist flexion test: a patient rests their elbows on a table and allows the wrist to fall forward freely. A person with carpal tunnel syndrome will experience numbness and tingling in their fingers within one minute. The more quickly the sensation or numbness appears, the more severe the condition.

Treatments for Carpal Tunnel Syndrome

Carpal tunnel syndrome treatment can be non-surgical or surgical, though conservative approaches are usually recommended first unless the condition is more severe. Non-surgical treatments include:

wearing a wrist splint at night
Taking nonsteroidal anti-inflammatory drugs
Cortisone injections
Lifestyle changes, such as moving the keyboard position, changing hand and wrist positions during activities, exercises, and heat treatments

Surgery is recommended when the non-surgical approaches fail or the case has become severe. The goal of surgery is to increase the size of the carpal tunnel to decrease the pressure on the median nerve and tendons within it.

It is an outpatient procedure performed under local anesthesia where the transverse carpal ligament that covers the carpal tunnel is cut into the base of the palm. Following surgery, patients experience discomfort for 24 to 72 hours and can have stitches removed after 10 to 14 days. Recovery times can vary depending on a patient’s age, general health, and severity of the carpal tunnel syndrome, but all those who’ve undergone the surgery will need to avoid heavier activities with the affected hand for 4 to 6 weeks.

Prevention Strategies

Carpal tunnel syndrome is avoidable but difficult to prevent as it can be caused by so many different activities. Some prevention methods a person can adopt include:

Taking frequent rest breaks from repetitive activities
Engaging in conditioning and stretching exercises before and after activities
Avoiding flexing and extending the wrists repeatedly
Sleeping with wrists held straight
Keeping wrists straight when using tools

Make an Appointment with our Orthopedic Surgeons

We at Proliance Pacific Rim Orthopedic Surgeons strive to help our patients achieve a return to normal activity through compassionate and exceptional care using evidence-based medicine in a patient-friendly environment. We are committed to bringing you a high standard of care that is patient-focused, with the goal of improving your quality of life.