Does wrist or hand pain wake you up at night? Do you shake your wrist to stop the pain? Are you someone who types or holds the phone a lot? You may suffer from Carpal Tunnel Syndrome.
Carpal Tunnel Syndrome affects about 3 to 6 percent of American adults. It is often seen in people whose work or hobbies require repetitive motions of the wrist and hand. These include musicians, hair stylists, assembly line workers (especially those who operate vibrating tools), IT professionals and those who use keyboards.
The result can be burning, numbness or pain in the wrist and hand. This can ultimately lead to decreased gripping strength and coordination.
How does Carpal Tunnel Syndrome develop?
The median nerve runs the length of the arm and provides feeling to the palm side of the thumb and fingers (except for the pinky) This nerve and a series of tendons run through a narrow channel between the wrist bones called the carpal tunnel. If the tendons become irritated and swollen, the tunnel becomes smaller and the media nerve can get squeezed or pinched.
Those with smaller bone structures may be more susceptible to Carpal Tunnel Syndrome. This is why the condition is seen more frequently in women than in men. Obesity is also a significant risk factor for developing Carpal Tunnel Syndrome.
Who is at risk of developing Carpal Tunnel Syndrome?
In addition to those whose work or hobbies require repetitive motions of the wrist and hand, some patients develop Carpal Tunnel Syndrome because of:
- Heredity: Some people have smaller carpal tunnels or may have other anatomic structures that reduce the space for the median nerve. This is why women are more prone than men to develop the condition.
- Pregnancy: Sometimes the hormonal changes that occur during pregnancy can cause water retention. This may lead to swelling in the hand and wrist that can result in a flare-up of Carpal Tunnel Syndrome.
- Chronic Disease or Illness: A number of chronic conditions, including diabetes, rheumatoid arthritis and thyroid disease, can increase the risk of developing Carpal Tunnel Syndrome. This is due to impacts to the nerve and the formation of bone spurs in and around the carpal tunnel bones.
Carpal Tunnel Syndrome Symptoms
- Numbness, weakness or pain in the hand, including decreased grip strength.
- A loss of strength and coordination, especially the ability to use your thumb to pinch.
- Burning, tingling or itching of the index and middle fingers.
- A sense of the hand “falling asleep” at night and awakening to a pins-and-needles sensation.
- A worsening of symptoms as the day progresses, perhaps while engaged in activities like driving, holding a phone or reading a paper.
How Carpal Tunnel Syndrome is Diagnosed
First, your doctor will take your full medical history. Then he or she will examine your hands, arms, shoulders and neck, looking for signs of tenderness, swelling, warmth. He or she will then examine the median nerve and the carpal tunnel area and perform a series of specific clinical test maneuvers. These tests will determine pain patterns and check for strength, sensation and proper nerve function. Your doctor may:
- Bend and hold your wrists in a flexed position to see if it results in numbness or tingling in your hands.
- Tap over the median nerve in the carpal tunnel to recreate paresthesia.
- Touch your fingertips and hands with a special instrument to see how much feeling you have in those extremities. Your eyes will be closed during this exercise.
- Check for weakness in the muscles around the base of your thumb.
Imaging Tests to Diagnose Carpal Tunnel Syndrome
Imaging tests may be ordered to look for things like a fracture, arthritis, a cyst or tumor.
- Ultrasounds provide a look at the bones and tissues in your arm and wrist to detect signs of median nerve compression.
- X-rays help your physician eliminate other potential causes of your pain, such as arthritis, ligament injury or a fracture.
- Magnetic resonance imaging (MRI) scans of the soft tissues in your arm and hand can assess whether abnormal tissue or damage to the median nerve itself (perhaps from injury or tumor) might be the cause of your pain.
- Electrophysiological tests measure how well your median nerve is working and can determine if there is too much pressure on the nerve. These include nerve conduction studies that measure the signals that travel along the nerves of your hand and arm. The results provide a “road map” to determine the severity of your nerve impingement.
- Electromyograms (EMG) measure the electrical activity in muscles to determine if you have suffered nerve or muscle damage.
Your doctor may also order lab tests to rule out underlying conditions, such as diabetes, hypothyroidism and rheumatoid arthritis.
Non-Surgical Treatments for Carpal Tunnel Syndrome
Like most conditions, Carpal Tunnel Syndrome is best treated early for greater success. Your physician will most likely begin treatment with conservative measures such as:
- Splinting to stabilize movement in the wrist.
- Lifestyle changes, including efforts to reduce or eliminate repetitive movements, or at least incorporating designated rest periods into the day. Improved posture and form can help, too.
- Ice to reduce swelling.
- Exercises to strengthen and stretch the tendons that may be causing the nerve irritation.
- Reducing pain and discomfort with over-the-counter anti-inflammatory medications.
If these efforts do not result in relief, your doctor may suggest prescription corticosteroid or lidocaine injections into the wrist to relieve pressure on the median nerve.
If these minimally invasive measures are unsuccessful, some patients may be candidates for regenerative injections to restore the normal chemical environment within the carpal tunnel and aid in nerve recovery.
Surgical Treatments for Carpal Tunnel Syndrome
During open carpal tunnel release surgery, a small incision is made in your palm so your physician can view the inside of your hand and wrist. He or she will then cut the transverse carpal ligament to increase the size of the tunnel and decrease pressure on the median nerve. Although the ligament will gradually grow back together after surgery, there will still be more space in the carpal tunnel to relieve nerve compression.
In endoscopic carpal tunnel release surgery, your doctor directs a small camera (endoscope) through small incisions in your hand. He or she then uses a special knife to cut the transverse carpal ligament. This is similar to what occurs during the open carpal tunnel release procedure.
Both of these procedures are generally done on an out-patient basis under local or mild general anesthesia. Most patients see relief in their symptoms, although full recovery may take many months. Patients should also commit to physical therapy and/or regular hand and wrist exercises.
Early treatment is key. Patients who ignore the symptoms of Carpal Tunnel Syndrome risk severe muscle atrophy that may make a complete recovery impossible.