Carpal tunnel syndrome is an increasingly common condition where the affected individual experiences pain, numbness, and tingling in one or both of the hands and possibly in the arms. It can affect one hand or both depending on the severity of symptoms and the underlying related cause. Carpal tunnel syndrome tends to occur when the major median nerve to the hand is compressed as it travels through the wrist.
Most carpal tunnel syndrome sufferers notice symptoms getting worse over time. This makes early diagnosis and treatment especially important as mild symptoms can often be relieved with simple measures such as wearing a wrist splint or avoiding certain activities.
Left unchecked the pressure on the median nerve can lead to nerve damage and worsening symptoms. To manage this level of discomfort and prevent permanent damage, surgical intervention might be needed to take pressure off the median nerve. This can lead to increased recovery time.
To determine if your discomfort is related to carpal tunnel syndrome and what needs to be done to alleviate symptoms, it helps to get a better understanding of the affected anatomy and symptoms.
The Anatomy Of The Arm & Wrist
Carpal tunnel syndrome is essentially a narrowing of the passageway in the wrist. In a typical adult, this passageway is about an inch wide. The bottom and sides of the tunnel are formed by small wrist bones called carpal bones.
This carpal tunnel serves to protect the median nerve as well as the flexor tendons that help to bend the fingers and the thumb.
The top of the carpal tunnel is made of a strong band of connective tissue called the transverse carpal ligament. Since the boundaries are very rigid, the carpal tunnel cannot stretch of its own accord.
The median nerve originates as a group of nerve roots in the neck that comes together to form a single nerve in the arm. This median nerve travels down the arm and forearm, passes through the carpal tunnel at your wrist, before going into the hand. This is the primary nerve that provides feeling in the thumb and all of your fingers except the pinky. Nine specialized tendons bend the fingers and the thumb also travel through the carpal tunnel. These tendons are called flexor tendons.
Carpal tunnel syndrome is a narrowing of the tissues surrounding the flexor tendons swell, putting pressure on the median nerve. These tissues are called the synovium. Normally, the synovium lubricates the tendons, making it easier to move your fingers.
What Causes Carpal Tunnel Syndrome?
The majority of carpal tunnel syndrome cases are related to a combination of key factors. At the same time, a growing body of research has found that women and older individuals are more likely to develop the condition. Certain professions can increase your risk of developing COVID. This includes the following factors:
Heredity
Genetics can play an important factor in your risk of developing carpal tunnel syndrome, as the tunnel itself might be smaller in some people. Certain genetics can also lead to minor anatomic differences that change the amount of space for the nerve—and these traits can run in families.
Repetitive Hand Use
Repeating the same motion with the hands and wrists as part of your job, or routine activities with repetitive wrist motions can start to aggravate the tendons in the wrist, causing swelling and increasing the pressure on the nerve.
Hand & Wrist Posture
Certain activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve.
Pregnancy
The hormonal changes that occur during pregnancy can cause swelling, which can in turn affect the median nerve in the carpal tunnel.
Certain Health Conditions
Certain medical conditions like diabetes, rheumatoid arthritis, and thyroid gland imbalance can put an individual at increased risk for carpal tunnel syndrome.
What Are The Symptoms Of Carpal Tunnel Syndrome?
Common symptoms of carpal tunnel syndrome might include:
- Tingling, burning, and pain in the thumb and index, middle, and ring fingers
- Numbness in one or more fingers or the thumb
- A shock-like sensation that seems to radiate to the thumb and fingers
- Recurring pain or tingling that may travel up the forearm
- Weakness in the hand
- A loss of fine motor dexterity
With most cases of carpal tunnel syndrome early symptoms are minor and begin to worsen gradually without any notable specific injury. Many people note that their symptoms come and go at first. Though as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.
Many people with carpal tunnel syndrome notice increased discomfort while sleeping. This is often related to the way many people sleep with their wrists bent. This can exacerbate symptoms and even wake you up in the middle of the night, making it hard to get back to sleep again. Symptoms that occur during the daytime might be worse when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.
How Is Carpal Tunnel Syndrome Diagnosed?
Your physician will start with an evaluation of your general health as well as an updated medical history related to the symptoms you are experiencing. Then they will carefully examine your hand and wrist, which often includes performing several physical tests. This might include:
The physician pressing down or taping along the median nerve inside of your wrist to note any numbness or tingling in the fingers.
- Bending and holding your wrists in a flexed position to see if it induces numbness or tingling in your hands
- Testing the sensitivity of your fingertips by lightly touching them with a special instrument
- Checking for obvious signs of weakness in the muscles around the base of your thumb
- Looking for notable signs of atrophy in the muscles around the base of the thumb
- Comparing the muscles in one hand to the other, in a case where symptoms are limited to one hand
Electrophysiological tests might be needed to detect signs of nerve damage, or if there is another nerve condition, such as neuropathy that is contributing to your symptoms.
An MRI, CT Scan, or X-Rays will also be used to assess the severity of the narrowing of the carpal tunnel. This can also determine the need for invasive treatment or if non-surgical treatment can provide effective relief of symptoms.
Treatment For Carpal Tunnel Syndrome
Carpal tunnel syndrome tends to worsen over time without some form of treatment. For this reason, it is important to be evaluated and diagnosed by your doctor early on. If it is caught early, your physician might be able to slow or stop the progression without the use of surgery.
Nonsurgical Treatment For Carpal Tunnel Syndrome
With early diagnosis, the symptoms of carpal tunnel syndrome can often be relieved without surgical intervention. This might include things like
- Using a wrist brace
- Wearing a splint or brace reduces pressure on the median nerve by keeping your wrist straight
- Specific stretches and exercises to improve muscle flexibility and range of motion
- Nonsteroidal anti-inflammatory medications
- Activity modification
- Improving your workstation
- Steroid injections to relieve inflammation
Surgical Treatment For Carpal Tunnel Syndrome
If nonsurgical treatment fails to relieve your carpal tunnel symptoms after a period of time, your physician might recommend surgery.
The surgical procedure most often used to treat carpal tunnel syndrome is called a “Carpal Tunnel Release.” It calls for relieving the pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. This effectively increases the size of the carpal tunnel itself which then decreases the pressure on the median nerve.
This surgical procedure is often performed under general anesthesia, or local anesthesia, which numbs just your hand and arm.
The physician then makes a small incision in the palm of your hand to better view the hand and wrist through this incision. They will then divide the transverse carpal ligament which increases the size of the tunnel and decreases pressure on the median nerve.
Recovering From Carpal Tunnel Surgery
After the surgical procedure, you will need to elevate your hand above your heart and move your fingers to reduce swelling and prevent stiffness. Some pain, swelling, and stiffness are natural after the procedure. Minor soreness in your palm may last for several weeks to several months.
A physical therapist will guide you through a somewhat gradual recovery process to improve your grip strength and range of motion. Most people see a noticeable improvement in about 2 to 3 months after carpal tunnel surgery. Though for more severe cases, complete recovery might take as long as 6 to 12 months.