Carpal tunnel syndrome is caused by increased pressure of the median nerve at the wrist. It is a very common condition that causes numbness, tingling and pain at the hand and wrist. The median nerve provides sensation to the thumb, index, and middle fingers, and to half of the ring finger. The small finger (the “pinky”) is typically not affected.
The symptoms of carpal tunnel syndrome may include:
• Numbness & tingling, often worse at night, especially in the thumb, index & middle fingers
• Discomfort in wrist, hand or fingers
• Waking up at night, having to shake hand or hold over the side of the bed
• Fingers feeling fuzzy or swollen
• Weak pinch
• Dropping objects
Symptoms usually start gradually, with frequent numbness or tingling in the fingers, especially the thumb, index and middle fingers. Some patients say their fingers feel useless and swollen. The symptoms often appear first during the night. The dominant hand is usually affected first and produces the most severe symptoms. Some people may wake up feeling the need to “shake out” the hand or wrist. Certain activities such as talking on the phone, reading a book or newspaper, or driving may exacerbate symptoms. Symptoms are initially intermittent but can become permanent, as severity of the condition increases. Hand weakness may make it difficult to perform fine manual tasks or grasp small objects. In chronic or untreated cases, the muscles at the base of the thumb may waste away (thenar atrophy).
Many factors can contribute to the development of carpal tunnel syndrome. These factors include:
• Hereditary factors (carpal tunnel can run in the family)
• Older age
• Female gender
• Pregnancy (due to fluid retention)
• Hemodialysis (in kidney failure)
• Wrist factures
• Hand or wrist deformity
• Arthritis (including rheumatoid arthritis & gout)
• Diabetes
• Thyroid dysfunction
• Alcoholism
• A mass in the carpal tunnel (ganglion cyst)
• Amyloidosis (abnormal protein deposits)
Workers at risk for carpal tunnel syndrome are those who do jobs that involve repetitive finger Repetitive activities in the workplace that include forceful or repetitive gripping or vibration can increase symptoms.
Early diagnosis and treatment are important to avoid permanent damage to the median nerve. The diagnosis of carpal tunnel syndrome is based in most cases on history and physical examination. When performing the physical exam, your Surgeon will perform sensation testing on your fingers and hand. They may also perform sensory testing of the forearm and arm because finding numbness outside the median nerve area may suggest a different problem. Your doctor may also perform clinical tests such as the Tinel’s test, Phalen’s and Durkan’s test. These tests are designed to increase pressure on the median nerve causing your symptoms to become more evident or worsen. Electrodiagnostic studies (EMG) may also be used to confirm the diagnosis or help differentiate from other conditions that might present with similar complaints, such as diabetic neuropathy or cervical radiculopathy. Ultrasound can also be used in the office to assess for abnormal median nerve diameter.
Non-surgical treatment
• Oral anti-inflammatory medication
• Wrist splinting, especially at night
• Activity modification
• Hand therapy/home exercise program
• Steroid injections (cortisone shots)
Other treatments focus on ways to change the environment to decrease symptoms. This is often seen in the workplace, where you can make modifications to help with carpal tunnel. These changes might include raising or lowering your chair, moving your computer keyboard or changing your hand/wrist position while doing activities.
Surgery is recommended when carpal tunnel syndrome does not respond to a trial of conservative management or has already become severe. The goal of surgery is to increase the size of the carpal tunnel in order to relieve the pressure on the median nerve. This is done by cutting (releasing) the ligament (transverse carpal ligament) that covers the carpal tunnel at the base of the palm. Surgery is usually performed under local anesthetic through a small incision at the wrist.
• Have an outpatient procedure under local anesthetic (pain numbing medication). You will remain wide awake during the procedure. For some patients, mild sedation might be used (similar to sedation during colonoscopy).
• Have a bulky dressing around your wrist for a few days
• Have your stitches removed 10 to 14 days after surgery
• Be unable to do heavier activities with the affected hand for 2-6 weeks
• Have relief from most carpal tunnel syndrome symptoms in most cases
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