Carpal tunnel syndrome is a very common source of hand pain and numbness. Often times it’s not noticed – or diagnosed – right away, because the symptoms usually begin gradually, and not as a result of a specific or discrete injury.
Carpal tunnel syndrome is more common in women, and then to be more severe on the thumb side of the hand. Some of the most common symptoms verbalized by patients who suffer from carpal tunnel are numbness, tingling, and pain in the hand; “strange sensations” and/or pain traveling up the arm towards the shoulder; and/or an electric shock type of feeling that occurs in the thumb and first few fingers of the hand.
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome occurs when the median nerve – which travels down the forearm and into the hand via the wrist, and controls the muscles around the base of the thumb as well as the feeling of the palm side of the thumb, index finger, and long fingers – is compressed. The carpal tunnel is a narrow, “tunnel-like” structure in the wrist. The bottom and sides of the tunnel are comprised of the wrist (carpal) bones, while the top of the tunnel is covered by a very strong band of connective tissue (transverse carpal ligament). The tendons that work to bend the fingers also travel through this tunnel – they are called the flexor tendons.
When the tissue, or synovium – which works to lubricate the tendons so that they’re able to move easier – swells, it puts pressure on the median nerve. Over time, this swelling narrows the already limited space that exists in the carpal tunnel which, in turn, crowds the nerve.
What Are the Symptoms of Carpal Tunnel Syndrome?
In the majority of those with carpal tunnel syndrome, there is no one particular cause. However, there are a multitude of factors that can contribute to the development of the ailment, including:
Heredity – this is the most important factor. The carpal tunnels are smaller in some individuals, which is a trait that can run in families.
Hormonal changes, such as those that occur during pregnancy.
Repetitive use of the hands and/or wrists.
Age – carpal tunnel syndrome tends to occur more frequently in older individuals.
Certain medical conditions, including diabetes, rheumatoid arthritis, and thyroid issues can be a contributing factor.
It should be noted that the symptoms of carpal tunnel syndrome can occur at any time. Initially they will come and go but, over the course of time, they will become constant. Carpal tunnel syndrome can cause feelings of weakness and/or clumsiness, and can cause people to experience problems with performing delicate hand maneuvers, like buttoning a shirt.
In addition, many people tend to sleep with their wrists curled, which can cause nighttime pain severe enough to awaken the individual. Otherwise, the pain tends to occur when an individual is holding an object – like a phone or computer mouse – or while driving or reading. Sometimes moving or shaking the affected hand can help to temporarily decrease symptoms.
How is Carpal Tunnel Syndrome Diagnosed?
At your doctor’s visit, your physician will review your health history with you, as well as the symptoms that you’ve been experiencing. Your physician will also perform a thorough examination of your hand(s), checking for weakness in the muscles around the base of your thumb, bending and holding your wrists in certain positions to check for numbness or tingling, as well as x-rays and/or an electrophysiological test, which is electrical testing of the median nerve function. The electrophysiological test is often done to aide in the diagnosis, as well as help clarify the best course of treatment for your particular situation.
Treatment Options – Surgical vs. Nonsurgical
Without treatment, carpal tunnel syndrome will typically worsen over time. However, if caught in the early stages, it can be managed or, sometimes, the progression halted all together by modifying activities and such. If treatment is necessary, there are a variety of nonsurgical options available, such as:
Changes in activity – as mentioned previously, simply changing the way you perform certain tasks – like typing – can help immensely.
Medications – Anti-inflammatory medications such as ibuprofen can help to relieve both pain and swelling.
Bracing or splinting – By wearing a brace or splint during activities that tend to aggravate symptoms – or while sleeping – the wrist can be held in a neutral position, thereby avoiding irritation to the medial nerve.
Steroid injections – an injection of a corticosteroid can often provide relief, but symptoms may return.
If nonsurgical treatment fails or becomes no longer sufficient to manage symptoms, your orthopaedic physician may recommend surgical intervention. This is especially true of more severe cases of carpal tunnel syndrome, simply because the likelihood of nonsurgical treatment not working. One of the newer surgical treatments is an endoscopic method. This allows for smaller incisions than the traditional surgical technique, and may speed recovery as well. If surgery is opted for, your orthopaedic physician will discuss with you the surgical procedure that best suits your particular circumstance.
Recovery and Long Term Outcomes
After surgery, you may experience some pain, swelling, and stiffness, which is completely normal. You should be able to resume light activities relatively soon after surgery. Your physician will let you know when you can return to normal activities and/or work, as well as any restrictions that you may be asked to follow.
Most patients experience symptomatic relief after surgery, but it should be noted that recovery may be gradual – especially in more advanced cases. Complete recovery can take up to a year and physical therapy may be recommended by your physician to assist with regaining strength, mobility, and function.
If carpal tunnel syndrome is something that you think (or know) you’re suffering from, please don’t hesitate to give us a call! Dr. Hurlbut specializes in disorders of the upper extremity and has highly advanced training in a multitude of surgical procedures.