Carpal Tunnel

Carpal Tunnel Syndrome Overview

Carpal tunnel syndrome (CTS) is a painful condition that results from compression of the median nerve, which runs from the forearm into the palm at the wrist. Wrist and/or hand discomfort typically begins gradually and is not related to a specific injury. Women are three times more likely to develop CTS than men, possibly because the carpal tunnel itself is smaller.

The passageway through which the nerve runs is known as the carpal tunnel. The median nerve provides feeling to the palm side of the thumb and fingers (not the little finger). And it provides nerve signals to move the muscles around the base of the thumb.

A number of factors contribute to CTS, but there is no single cause. Rather, experts point to a combination of factors and conditions. There are conflicting reports and research about the role of workplace factors, like repetitive motion and computer use, in developing carpal tunnel syndrome.

Wellstar neurologists are expert in diagnosing and treating carpal tunnel syndrome. If you are concerned about symptoms, make an appointment to learn more about your condition and what you can do to feel better.

Symptoms

Pressure on the median nerve traveling through the carpal tunnel causes swelling of the tissues surrounding the tendons in the wrist. The swelling narrows the space inside the carpal tunnel and, over time, crowds the nerve. Symptoms can worsen over time and with excessive use of the wrist.

Tingling or numbness. The tingling can affect the fingers or hand, especially the thumb, index, middle or ring fingers—not the little finger. The sensation often comes while holding a steering wheel, phone or newspaper. Often the feeling is strong enough to wake you from sleep. As the disorder worsens the numbness may become permanent.
Weakness. CTS causes numbness in the hand or weakness of the thumb’s pinching muscles, which are controlled by the median nerve. As a result you may drop objects.
Electric shock like feeling. This typically affects the thumb, index and middle finger..
Unusual sensations and pain. The pain can travel up the arm toward the shoulder.

Risk Factors

Carpal tunnel syndrome is typically a combination of factors rather than a problem with the median nerve itself. The issue may be hereditary—some people are born with a narrower carpal tunnel than others. Other factors:

Trauma or injury to the wrist, such as a sprain or fracture, that cause swelling
Overactive the pituitary gland
Hypothyroidism (under-active thyroid)
Joint or bone disease such as arthritis
Mechanical problem with the wrist
Certain repetitive activities or motions
Repeated use of vibrating hand tools
Fluid retention related to pregnancy or menopause
Being female
Having diabetes

Despite considerable media attention, there is no compelling evidence that links carpal tunnel syndrome to repetitive and forceful movements of the hand and wrist during work or leisure activities.

Carpal Tunnel Syndrome Prevention

Although there are no certain ways to prevent carpal tunnel syndrome, you can reduce the chance of developing the condition by minimizing stress on the hands and wrists. Other strategies:

Reduce force and relax your grip. As you go about your day, concentrate on using less force for daily manual activities, such as typing on a keyboard or operating a cash register. If you do a lot of handwriting, use an oversized pen with a soft grip adapter.
Take regular breaks to give your hands and wrists a rest. Gently stretch and bend the hands, and turn away from your screen or other task briefly. Breaks are especially important if you use vibrating equipment.
Pay attention to posture. Using poor posture can cause shoulder and neck compression, which can affect your wrists and hands. Avoid rolling shoulders forward. While typing, adjust your seat and keyboard to keep your wrists neutral, which means not bent up or down.
Keep the hands warm. Cold can worsen the pain and stiffness.
Consider ergonomic enhancements. Wrist rests, ergonomic keyboards and other equipment may help some people, though research on the impact of these devices is not definitive.

If your symptoms are mild you can take steps to prevent them from worsening. Examples are:

Strengthen the muscles of the forearm by squeezing a tennis ball at regular intervals.
Stretch your fingers and wrists every hour.
Take over the counter pain relievers as prescribed and with the approval of your doctor.
Use cold packs to reduce occasional swelling.

Carpal Tunnel Syndrome Diagnosis

The earlier CTS is diagnosed, the more possible it is to avoid permanent nerve damage. Make an appointment with your Wellstar neurologist if your symptoms are similar to those of carpal tunnel syndrome. Diagnosis begins with a physical examination of the hands, arms, shoulders and neck.

The wrist will be examined for signs of swelling, tenderness, warmth and discoloration. Fingers will be tested for sensation (feeling) and the muscles at the base of the hand will be examined for strength and any signs of atrophy.

Based on an examination and tests (see below) the doctor will assess whether the symptoms suggest a diagnosis of CTS, or if they are associated with another condition.

Tools and Tests

Because some symptoms of carpal tunnel syndrome mimic symptoms of other conditions, it may be necessary to conduct specific tests that try to produce the symptoms.

X-ray: An x-ray can help rule out certain other causes of wrist pain, like a fracture or arthritis.
Tinel test: The neurologist will tap or press on the median nerve. A positive result yields tingling in the fingers or a shock-like sensation.
Phalen (wrist-flexion) test: The patient holds the forearms upright by pointing the fingers down and pressing the backs of the hand together. Carpal tunnel syndrome is suspected if one or more symptoms are felt within one minute.
Nerve conduction study: This may be used to confirm a diagnosis. Electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed of the nerve impulses is measured.
Electromyography: A small needle is inserted into a muscle and electrical activity (viewed on a screen) can reveal the amount of damage to the median nerve.
Ultrasound: This noninvasive imaging test can show impaired movement of the median nerve.

Carpal Tunnel Syndrome Treatment

Your doctor will recommend treatment of your carpal tunnel syndrome based on factors including:

Your age, overall health and medical history
Extent /severity of the condition
Your tolerance for specific medications, procedures or therapies
Expectations for the course of the disease
Your personal preferences

Non-surgical Treatment Options

Splinting of the hand. This prevents wrist movement and decreases compression of the nerves inside the carpal tunnel.
Medications. Choices are oral or injected (into the carpal tunnel space) anti-inflammatory medicines to reduce swelling. In some cases steroid shots are used to reduce tendon swelling and ease pressure on the median nerve.
Lifestyle changes. Examples are altering your workspace to ensure your wrists are neutral (not bent up or down) when you use a keyboard.
Changing the way you use your hand or elbow. The goal is to reduce or eliminate activities that cause discomfort.

If you have been diagnosed with a subdural hematoma your neurosurgeon will fully explain the options and recommend the most appropriate surgery for your condition and health status. Choices include:

Surgery

If symptoms persist for six months despite non-surgical techniques, your neurologist may recommend talking with a Wellstar neurosurgeon about surgery. Carpal release surgery is one of the most common surgical procedures performed in the US.

The purpose is to expand the space inside the carpal tunnel by cutting the ligament pressing on the nerve. The surgery is done under local anesthesia on an outpatient procedure. There are two categories—your doctors will make a recommendation based on your condition, health status and other factors.

Open release surgery is the traditional method and involves making an incision of up to two inches in the wrist, then cutting the carpal ligament to enlarge the carpal tunnel.
Endoscopic surgery may allow faster recovery and less post-operative discomfort. The surgeon makes one or two half-inch incisions in the wrist and palm and inserts a tube fitted with a tiny camera. Using the image on the screen the surgeon uses small tools to cut the ligament.

Ongoing Care for Carpal Tunnel Syndrome

Complete recovery following carpal tunnel surgery can take months and sometimes there is a recurrence of CTS. Post-surgical complications can include discomfort, infection, nerve damage and stiffness. Your doctor will likely recommend physical therapy to help you regain strength and function in the hand and wrist.

Wellstar physical therapists offer comprehensive service at a number of convenient locations. The goal is to gradually regain normal use of the hand, while avoiding forceful hand motions and extreme wrist positions. Your doctor will recommend steps to help reduce ongoing symptoms as you heal from surgery. These might include:

Take quick breaks from repetitive activity involving your hands
Rotate the wrists and stretch the palms and fingers
Take pain relievers as recommended
Wear a wrist splint at night. These are generally available over-the-counter and should be snug, but not too tight
Avoid sleeping on your hands

Some patients find relief from participating in activities like yoga and using high-intensity ultrasound therapy to reduce pain and promote healing.

Rehabilitation

The Wellstar Kennestone Outpatient Neuro-Rehabilitation program serves patients in the acute care hospital setting, inpatient rehab unit and outpatient settings. There are four locations—Wellstar Cobb Medical Center, Wellstar Kennestone Regional Medical Center, Wellstar Douglas Medical Center (speech only) and Wellstar Windy Hill (speech only).