by Phil Burr, PA-C at The Orthopedic Institute at Southwest Health
You wake up in the middle of the night, and it feels like your hand is numb and tingling. You shake your hand to wake it up, and it goes away. You fall back asleep and don’t think much about it until you’re driving down the road when it happens again. You may also notice your hand getting numb while talking on the phone, typing, or washing dishes. This is starting to be a problem, but what’s going on? These are common, early symptoms of Carpal Tunnel Syndrome.
Carpal Tunnel Syndrome is a compression of a nerve that travels through the front of your wrist (palmar aspect). The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and sides of the tunnel are formed by small wrist (carpal) bones and the roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament. There are nine tendons and one nerve (median nerve) that travel through the carpal tunnel. That nerve can become compressed when the tunnel becomes narrowed or when the contents of the tunnel swell putting pressure on the nerve.
Many people get carpal tunnel syndrome that is mild and comes and goes. For some, it can worsen and become constant. If severe carpal tunnel syndrome goes untreated, then permanent nerve damage can occur resulting in permanent weakness and numbness.
Carpal Tunnel Syndrome can be caused by many factors. In general, women and people over 45 are more likely to suffer from Carpal Tunnel Syndrome. Other factors that increase the risk of developing Carpal Tunnel Syndrome are heredity, repetitive hand use, frequent bending of the wrist (talking on the phone), frequent bending backward of the wrist (driving), pregnancy, diabetes, rheumatoid arthritis, wrist fractures, and thyroid problems.
What are the symptoms of Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome typically affects the thumb, index, middle, and ring fingers. The symptoms can include numbness, tingling, burning, pain, shock-like sensations, and weakness. For some, this pain and tingling can travel up the arm all the way to the shoulder. It can cause feelings of clumsiness, such as difficulty fastening buttons or sorting papers. People also report dropping things or feeling like they might drop things.
In many cases, the symptoms of Carpal Tunnel Syndrome begin gradually and for no apparent reason. There is typically no injury. The symptoms often come and go at first, but as the condition worsens symptoms become more frequent and last longer. Night-time symptoms are very common because many people sleep with their wrist bent. Holding objects for a long period of time with the wrist bent forward or backward can worsen the symptoms; examples of this include using a phone, driving, or reading a book. Many people find that moving or shaking their hands helps relieve their symptoms.
How do I know if I have Carpal Tunnel Syndrome?
When you come in for evaluation of possible Carpal Tunnel Syndrome, your practitioner will talk with you about your general health, your medical history, and your symptoms. The practitioner will examine your arms looking for numbness, weakness, and decreased muscle size. They will often try to reproduce your symptoms by tapping and pushing along the nerve in the carpal tunnel and by holding your wrist in a bent position. To confirm the diagnosis, they may order a test called an EMG/NCV (electromyogram and nerve conduction velocity) study. These tests help evaluate nerve or muscle damage. Your practitioner can also help ensure the carpal tunnel is the problem and not a nerve getting pinched or irritated at another area such as the neck, shoulder, or elbow. Other tests that are less routinely ordered and are not always needed are x-rays, ultrasound, and MRI (magnetic resonance imaging).
What Treatment can help Carpal Tunnel Syndrome?
Although it is a gradual process, for most people Carpal Tunnel Syndrome will worsen over time without some form of treatment. If treated early, then it may be possible to slow or stop the progression of Carpal Tunnel Syndrome. Mild Carpal Tunnel Syndrome can often be treated with bracing, decreasing inflammation, rehabilitation, and avoidance of aggravating activities.
- Braces are typically used at night while sleeping or during the day when doing activities that make your symptoms worse.
- Inflammation can be decreased by taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Steroid injections are also powerful anti-inflammatory agents that can help treat and diagnose carpal tunnel syndrome.
- Rehabilitation is often done with a home exercise program or by using the assistance of an occupational or physical therapist.
- Activity modification such as avoiding keeping your wrist bent forward or backward for a long period of time can help slow or stop the progression of symptoms.
Moderate and severe Carpal Tunnel Syndrome may not respond to the treatments listed above, and after a period of time, your doctor may recommend surgery. Carpal tunnel release surgery is typically done on an outpatient basis, so you should be home recovering the same day. You should expect some pain, swelling, and stiffness after your procedure. You will be allowed to use your hand for light activities such as driving, self-care, and light lifting and gripping. Your surgeon will talk with you about when you will be able to return to work and whether you will have any restrictions on your work activities. The numbness and weakness you had before surgery typically goes away within two to three months after surgery, but if you have severe chronic Carpal Tunnel Syndrome prior to surgery, this could take additional time. Although complications are possible with any surgery, the surgeon will take steps to minimize these risks. Possible complications of carpal tunnel release surgery are bleeding, infection, and nerve injury. The majority of patients who have carpal tunnel release surgery have complete relief of their symptoms.