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Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand and forearm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.
In most patients, carpal tunnel syndrome gets worse over time. If untreated for too long, it can lead to permanent dysfunction of the hand, including loss of sensation in the fingers and weakness. For this reason, it is important to diagnose and treat carpal tunnel syndrome promptly.
Symptoms of Carpal Tunnel Syndrome
Early symptoms can often be relieved with simple measures like:
- Wearing a wrist splint while sleeping
- Exercises to keep the nerve mobile
- Avoiding certain activities that aggravate your symptoms
- A steroid injection into the carpal tunnel
If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.
Anatomy of the Carpal Tunnel
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 bones called carpal bones.
The carpal tunnel contains the median nerve and flexor tendons that bend the fingers and thumb. The roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament. Because these boundaries are very rigid, the carpal tunnel has little capacity to stretch or increase in size.
The median nerve originates as a group of nerve roots in the neck; these roots then come together to form a single nerve in the arm. The median nerve travels down the upper arm, across the elbow, and into the forearm, then passes through the carpal tunnel at the wrist on its way to the hand and fingers. It separates into several smaller nerves along the way, particularly once it reaches the palm. These nerves allow for feeling in the thumb, index finger, middle finger, and half of the ring finger (the thumb side).
The nine tendons that bend the fingers and thumb also travel through the carpal tunnel with the nerve. These tendons are called flexor tendons because they flex the fingers and thumb.
Description
Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when the tissue surrounding the flexor tendons (known as synovium) swells, putting pressure on the median nerve and reducing its blood supply. This abnormal pressure on the nerve can result in numbness, tingling, pain, and weakness in the hand.
Causes
Most cases of carpal tunnel syndrome are caused by a combination of factors. Studies show that women and older people are more likely to develop the condition. Other risk factors include:
- Heredity: The carpal tunnel may be naturally smaller in some people, or there may be anatomic differences that change the amount of space for the nerve.
- Repetitive hand use: Repeating the same hand and wrist motions over a prolonged period may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
- Hand and wrist position: Activities involving extreme flexion or extension of the hand and wrist for a prolonged period can increase pressure on the nerve.
- Pregnancy: Hormonal changes during pregnancy can cause swelling that results in pressure on the nerve.
- Health conditions: Diabetes, rheumatoid arthritis, and thyroid gland imbalance are associated with carpal tunnel syndrome.
Symptoms
Symptoms of carpal tunnel syndrome may include:
- Numbness, tingling, burning, and pain in the thumb and index, middle, and ring fingers
- Occasional shock-like sensations that radiate to the thumb and fingers
- Pain or tingling that may travel up the forearm
- Weakness and clumsiness in the hand
- Dropping things due to weakness or numbness
Tests To Confirm Diagnosis of Carpal Tunnel Syndrome
In some cases, you will need other tests such as:
- Electrodiagnostic tests: Measuring how well your median nerve is working and whether there is too much pressure on the nerve.
- Ultrasound: Using high-frequency sound waves to create pictures of bone and tissue.
- X-rays: Providing images of dense structures, such as bone.
- MRI scans: Providing better images of the body’s soft tissues than X-rays.
Treatment Options
For most people, carpal tunnel syndrome will worsen over time without some form of treatment. It is important to be evaluated and diagnosed by your doctor early on.
Nonsurgical Treatment If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved without surgery. Nonsurgical treatments may include:
- Bracing or splinting: Wearing a brace or splint at night to keep your wrist straight.
- NSAIDs: Taking anti-inflammatory medications such as ibuprofen and naproxen.
- Activity changes: Modifying activities that aggravate your symptoms.
- Steroid injections: Injecting corticosteroids into the carpal tunnel to relieve symptoms.
- Nerve gliding exercises: Exercises that help the median nerve move more freely.
Surgical Treatment If nonsurgical treatment does not relieve your symptoms, surgery may be recommended. The surgical procedure for carpal tunnel syndrome is called a carpal tunnel release. It involves cutting the ligament that forms the roof of the tunnel to relieve pressure on the median nerve.
Complications
The most common complications of carpal tunnel release surgery include bleeding, infection, wound healing issues, and nerve aggravation or injury. For most patients, surgery will improve the symptoms of carpal tunnel syndrome. Recovery may be gradual, and complete recovery may take up to a year.
References
Book an appointment with Anna Babushkina, MD, Hand and Upper Extremity Surgeon, or Kyle Bohm, MD, Hand and Upper Extremity Surgeon.