Could You Have Carpal Tunnel Syndrome?

Marked by numbness, tingling and other symptoms in the hand and arm, carpal tunnel syndrome is a condition caused by a compressed nerve in the carpal tunnel. The carpal tunnel is a narrow passageway located on the palm side of your wrist, and the syndrome can be related to the anatomy of the wrist, repetitive hand motions or other health problems. With the right treatment, carpal tunnel tingling and numbness symptoms can be restored along with wrist and hand function.

Causes and Risk Factors

Carpal tunnel syndrome is caused by pressure on the median nerve, which runs from the forearm through a passageway in the wrist (this is the carpal tunnel) to the hand. The median nerve is responsible for sensation on the palm side of the fingers, with the exception of the little finger, and it also provides nerve signals to move the muscles around the base of the thumb.

Any squeezing or irritation of the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. Wrist fractures and rheumatoid arthritis are examples of conditions that can narrow the carpal tunnel or irritate the nerve.

There is often no singular cause of carpal tunnel syndrome, and instead a combination of risk factors that contributes to its development. These risk factors may include:

• Anatomic factors: A wrist fracture, dislocation or arthritis that deforms the bones in the wrist can put pressure on the median nerve. In addition, people with smaller carpal tunnels may be at higher risk.
• Gender: Carpal tunnel syndrome is more common in women, possibly because their carpal tunnel area is naturally smaller than men.
• Nerve-damaging conditions: Chronic illnesses like diabetes can increase the risk of nerve damage, including to the median nerve.
• Inflammatory conditions: Conditions like rheumatoid arthritis that are marked by inflammation can damage the lining around wrist tendons and put pressure on the median nerve.
• Obesity: A significant risk factor for carpal tunnel syndrome.
• Bodily fluid balance alterations: Fluid retention can increase carpal tunnel pressure and irritate the median nerve. This is common during pregnancy and menopause.
• Other conditions: Conditions like thyroid disorders and kidney failure can increase risk.
• Workplace factors: Research is conflicting here, but it’s possible that working with vibrating tools or on an assembly line that requires repetitive wrist flexing can create harmful pressure on the median nerve. Similarly, studies have not been able to support the idea that continuous computer use might contribute to carpal tunnel syndrome.

Symptoms

Symptoms of carpal tunnel syndrome generally arrive gradually, and they may come and go at the start. Symptoms include:

• Tingling or numbness: Usually the thumb, index, middle or ring fingers are affected, but not the little finger. The sensation may move up from the wrist into the arm, and can occur while holding a steering wheel, phone or newspaper. It often wakes people from sleep.
• Weakness: Weakness in the hand and a tendency to drop objects are also potential symptoms.

If these symptoms persist and interfere with normal activities and sleep patterns, speak to your doctor. Without treatment, permanent nerve and muscle damage can take place.

Diagnosis and Treatment

Carpal tunnel syndrome can be diagnosed by your doctor using a series of questions, and potentially one or more tests. If a positive diagnosis is made, treatment should begin as soon as possible. Basic directions will likely include taking breaks to rest the hands, avoiding activities that worsen symptoms and applying cold packs to reduce swelling.

Other, nonsurgical treatment options may include:

• Wrist splinting: A splint that holds the wrist can help with nighttime numbness and tingling symptoms.
• NSAIDs: Nonsteroidal anti-inflammatory drugs like ibuprofen can help with pain, though there’s no evidence that they improve carpal tunnel syndrome directly.
• Corticosteroids: To relieve pain by decreasing inflammation and swelling. Usually injected, although it is also available in oral form.

In some cases, surgery might be required to treat carpal tunnel syndrome if it does not respond to other treatments. Surgery involves cutting the ligament pressing on the median nerve, which will relieve the pressure. There are two surgical techniques that may be used:

• Endoscopic surgery: A telescope-like device with a camera is used to see inside the carpal tunnel, guiding the surgeon to cut the ligament. This is often the less painful type of surgery.
• Open surgery: The surgeon makes an incision to the palm of the hand over the carpal tunnel and cuts the ligament.

Surgery risks can include incomplete release of the ligament, wound infections, scar formation and nerve or vascular injuries. The healing process usually takes several months, though the skin will heal in a few weeks.

Some people have found success with alternative treatments like yoga, hand therapy or ultrasound therapy. Always check with your doctor before beginning one of these forms of treatment.

Recurrence Prevention

There is no foolproof way to prevent carpal tunnel syndrome, but a few strategies can reduce stress on the wrists and hands:

• Reduce hand force and relax grip
• Take regular breaks from hand and wrist activities
• Watch form when bending your wrist
• Improve posture so shoulders aren’t rolled forward and don’t trickle down to the wrists and hands
• Change to a more comfortable computer mouse
• Keep your hands warm

If you’re dealing with intrusive symptoms of carpal tunnel syndrome, your doctor can offer treatment recommendations.

Our orthopedics practice has provided care for over 30 years. Our staff is trained handle a variety of issues, including sports medicine. We care for you and your family with the same state-of-the art techniques we use with BYU and Olympic athletes.

Sources:

“Carpal tunnel syndrome.” The Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/home/ovc-20313865

“Carpal Tunnel Syndrome – Topic Overview.” WebMD. http://www.webmd.com/pain-management/carpal-tunnel/tc/carpal-tunnel-syndrome-topic-overview#2