CARPAL TUNNEL SYNDROME
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What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome develops when pressure builds on the median nerve as the nerve passes through the carpal tunnel, a narrow passageway in the wrist surrounded by bones and ligaments. This pressure interferes with normal nerve function and commonly causes numbness, tingling, pain, burning sensations, or weakness in the thumb, index finger, middle finger, and part of the ring finger. Symptoms often begin gradually and may become more noticeable during activities that require repeated hand or wrist movements or while sleeping.
Without treatment, ongoing compression can reduce hand strength, limit grip and pinch function, and make everyday tasks more difficult. Many factors contribute to the condition, including repetitive hand motions, wrist injuries, arthritis, diabetes, pregnancy, and other conditions that increase swelling or reduce space within the carpal tunnel. Early evaluation and appropriate treatment can relieve nerve pressure, improve hand function, and help prevent permanent nerve damage.
What Causes Carpal Tunnel Syndrome?
The most common cause of carpal tunnel syndrome is ‘idiopathic’- meaning that we do not know what exactly causes it. This condition likely occurs from a combination of events.
Some risk factors include:
- Demographics: female sex, older age
- Health conditions: pregnancy, diabetes, thyroid disease, rheumatoid arthritis
- Hand and wrist position: activities that hold the hand in the extremes of flexion or extension can increase pressure on the median nerve
- Repetitive hand use: overuse of the flexor tendons running through the carpal tunnel can lead to inflammation and swelling of the tendons, leaving less space for the median nerve and contributing to its compression
- Heredity: inherited anatomic differences likely play a role in the development of this condition
Symptoms of Carpal Tunnel Syndrome
People experience symptoms of this condition differently. However, the most common symptoms include numbness/tingling, electric shocks, burning, or pain of the thumb, index and middle fingers. People with carpal tunnel will often complain of dropping objects, waking up in the middle of the night and losing hours of sleep per night. Severe carpal tunnel will present with weakness of the thumb and difficulty getting the thumb out of the palm of the hand.
Diagnosis of Carpal Tunnel Syndrome
Specialists can often diagnose this syndrome by confirming the symptoms and by performing a clinical examination including provocative physical examination tests to reproduce the symptoms. Patients may also undergo US (ultrasound) studies in our office to examine the median nerve when entering the carpal tunnel. At times Doctors require EMG and NCS (nerve conduction studies) to measure nerve conduction velocities to determine where and how the compression lies. PM&R or neurology doctors can perform EMG/NCS, which involves placing small needles the size of acupuncture needles in the forearm and hand that gives small electric shocks to determine nerve function and speed.
Treatment of Carpal Tunnel Syndrome
Treatment of this condition includes conservative non-operative treatment options and surgical options. Non-operative treatment may benefit mild carpal tunnel syndrome, but may only offer temporary relief. Lifestyle modifications involving reducing repetitive hand and wrist movements and modifying activities to minimize prolonged extremes of wrist flexion and extension can be helpful. Wearing a wrist cock-up brace is recommended to maintain the wrist in 20 degrees extension, which maximizes the space within the carpal tunnel. While NSAID medications have shown equivocal results in scientific trials, some patients may find them beneficial for managing symptoms.
Cortisone injections can aid in confirming the diagnosis in uncertain cases and have been associated with successful symptom resolution following surgical release. Endoscopic carpal tunnel release offers a minimally invasive approach, employing an endoscopy camera the size of a small pen inserted through a small incision at the wrist crease. Open carpal tunnel release involves a traditional surgical approach with an incision made in the palm over the carpal tunnel ligament.
If you would like to speak to a Texas Orthopedic Hand and Wrist Specialist, give us a call at 817-697-4038, or contact us over the web. Tele-medicine appointments are also available.
