Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common problem that affects the
use of your hand, and is caused by compression of the median nerve at the
wrist. It most often occurs when the median nerve in the wrist becomes
inflamed after being aggravated by repetitive movements such as typing
on a computer keyboard or playing the piano. It also seems to affect
professional artists fairly commonly – in particular, sculptors and
The "carpal tunnel" is formed by the bones, tendons and ligaments
that surround the median nerve. Since the median nerve supplies
sensation to the thumb, index and middle finger, and part of the ring
finger, and provides motion to the muscles of the thumb and hand, you
might notice numbness and weakness in these areas.
Hand and wrist pain
A burning sensation in the middle and index fingers
Thumb and finger numbness
An electric-like shock through the wrist and hand
These symptoms are often exaggerated when the wrist is bent
forward. This numbness or pain may be worse at night, and may actually
keep you awake. During the day, it may occur more often when you are
participating in activities that involve bending of your wrist.
Common Causes of Carpal Tunnel Syndrome
Diseases or conditions that may increase your chances of
developing carpal tunnel syndrome include pregnancy, diabetes,
menopause, broken or dislocated bones in the wrist, and obesity.
Additional causes include repetitive and forceful grasping with the
hands, bending of the wrist, and arthritis.
Any repetitive motions that cause significant swelling,
thickening or irritation of membranes around the tendons in the carpal
tunnel can result in pressure on the median nerve, disrupting
transmission of sensations from the hand up to the arm and to the
central nervous system.
Diagnosing Carpal Tunnel Syndrome
It is important to seek medical assistance when you first notice
persistent symptoms. Do not wait for the pain to become intolerable.
Before your doctor can recommend a course of treatment, he or she
will perform a thorough evaluation of your condition, including a
medical history, physical examination and diagnostic tests. Your doctor
will document your symptoms and ask about the extent to which these
symptoms affect your daily living. The physical examination will include
an assessment of sensation, strength and reflexes in your hand.
If conservative treatment such as medication or physical therapy
does not provide sufficient relief, your doctor may perform diagnostic
studies to determine if surgery is an effective option. These diagnostic
studies may include:
- X-ray: An x-ray will show the bones of the wrist and determine
if any abnormalities may be contributing to carpal tunnel syndrome or
- Electromyogram and Nerve Conduction Studies (EMG/NCS): These
tests primarily study how the nerves and muscles are working together.
They measure the electrical impulse along nerve roots, peripheral nerves
and muscle tissue.
Conservative (Nonsurgical) Treatments
The main purpose of conservative treatment is to reduce or
eliminate repetitive injury to the median nerve. In some cases, carpal
tunnel syndrome can be treated by immobilizing the wrist in a splint to
minimize or stop pressure on the nerves. If that does not work, patients
are sometimes prescribed anti-inflammatory medications or cortisone
injections in the wrist to reduce swelling. Your doctor may suggest
specific types of hand and wrist exercises, which may be helpful.
Treatment for carpal tunnel syndrome may include rest, the use of a
wrist splint during sleep, or physical therapy. Conservative treatment
methods may continue for up to eight weeks.
When Surgery is Necessary
Only a small percentage of patients require surgery. Factors
leading to surgery include the presence of persistent neurological
symptoms and lack of response to conservative treatment.
If you experience severe pain that cannot be relieved through
rest, rehabilitation or nonsurgical treatment, you may be a candidate
for one of several surgical procedures that can be performed to relieve
pressure on the median nerve. The most common procedure is called carpal
tunnel release, which can be performed using an open incision or
The open incision procedure or carpal tunnel release, involves
the doctor opening your wrist and cutting the ligament at the bottom of
the wrist to relieve pressure. The endoscopic carpal tunnel release
procedure involves making a smaller incision and using a miniaturized
camera to assist the neurosurgeon in viewing the carpal tunnel. The
possibility of nerve injury is slightly higher with endoscopic surgery,
but the patient's recovery and return to work is quicker.
Recovery After Surgery
After surgery, a dressing will be applied to your hand. You
should leave this secured in place until your first office visit
following surgery. You may need bandages on one or both wrists depending
on your surgery. If this is the case, you may require extra assistance
at home with everyday activities. Your stitches can be removed about
10-14 days after surgery. Make sure you avoid repetitive use of the hand
for four weeks after surgery and avoid getting the stitches wet. You
will notice that the pain and numbness begins to improve after surgery,
but you may have tenderness in the area of the incision for several
Recurrence of symptoms after surgery for carpal tunnel syndrome
is rare, occurring in less than 5 percent of patients. A majority of
patients recover completely. To avoid injuring yourself again, it may
help to change the way you perform repetitive movements, the frequency
with which you perform the movements, and the amount of time you rest
between periods when you must perform these movements.