Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is basically a pinched nerve in the wrist.  The median nerve is a major nerve that supplies the upper arm, hand and fingers with sensations and provides motor function to the forearm muscles and fingers including gripping. This nerve passes through the carpal tunnel in your wrist. The carpal tunnel, which is made of bones and the transverse carpal ligament, is only an inch wide and contains the median nerve and nine finger tendons.  Carpal tunnel syndrome is a common condition.

What causes the pressure on the nerve?

Narrowing of the tunnel is frequently caused by overuse – repetitive hand and wrist motions that cause the tendons to swell and increase pressure on the nerve. Typing, cooking, and working with the hands and using vibrating tools. The tunnel can also narrow due to fractures, arthritis, fluid retention and joint dislocation. Diseases like hypothyroidism, rheumatoid arthritis, obesity and diabetes are associated with carpal tunnel syndrome. New science shows that carpal tunnel syndrome runs in families.

Risk factors include smaller carpal tunnels that can run in families, hormone changes during pregnancy that can cause swelling, and other health conditions such as diabetes, rheumatoid arthritis and thyroid disease have been associated with carpal tunnel syndrome.

What are the symptoms?

Symptoms of median nerve injury include:

• Pain, numbness, tingling, burning and discomfort in the hand and fingers. People who have carpal tunnel syndrome often shake their arms in an attempt to relieve numbness and tingling
• Numbness commonly affects the thumb, index, middle and ring fingers.
• A weak grip that causes involuntary dropping of things
• Occasional clumsiness that interferes with the ability to perform fine motor movements
• Pain and tingling that travels up the forearm
• Symptoms start gradually and worsen over time
• Symptoms typically worsen at night and in the morning hours, when driving a car, talking on the phone or reading a book. Any activity that causes the wrist to be bent forward or backward for long periods can aggravate the condition.

If other parts of your hand or fingers experience abnormal sensations, this suggests damage to nerves other than the median nerve. Receiving the correct diagnosis and treatment to relieve the pressure on the nerve can prevent nerve damage.

Diagnosis

Your OANC hand doctor will review your medical history, ask about your symptoms and conduct a physical examination including performing specific tests to evaluate the function of the median nerve and muscle strength.  Nerve conduction studies may be ordered to assess how well the median nerve is working. Imaging studies may be used to evaluate the nerve for signs of compression.

Treatment is based in part on the cause of the dysfunction.  The goal of treatment is to relieve the compression quickly to prevent damage, and to slow or stop progression of the condition. 

Nonsurgical Treatment

In early cases of carpal tunnel syndrome, when there is no nerve damage, symptoms can often be relieved, and function improved without surgery.

• The use of a brace or splint to put the wrist in a neutral position to relieve pressure. It may be worn at night and during the day to prevent aggravation of symptoms.
• Over the counter anti-inflammatory drugs can help relieve pain and inflammation.
• Activity modifications will help relieve pain and symptoms and can help to slow or stop progression of the syndrome.
• Steroid injections can relieve symptoms and calm flare-ups, but the effect is only temporary.
• Physical therapy with specific exercises can help the nerve move freely.
• If symptoms last for 6 months or longer without relief from nonsurgical management, surgery will be recommended.

Surgical Treatment

Carpal tunnel surgery is outpatient surgery to relieve pressure on the nerve. Surgical release will be recommended for patients who have failed to find relief with nonsurgical treatment. Surgery will improve symptoms. However, nerve injuries typically take a long time to recover and restore normal function. It can take up to a year to become pain and symptom free after surgery. The good news is that a recurrence of carpal tunnel syndrome is rare after surgical correction.

Untreated carpal tunnel syndrome can cause permanent disability. So, don’t wait. Call OANC with offices in Chico, California to schedule a consultation. Find out what is causing your problem and what can be done. All OANC orthopedic surgeons are board-certified, trained and experienced in the diagnosis and treatment of hand and nerve disorders. You will always be treated with respect and compassion. We are here to help.