What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome occurs when you have numbness, weakness or pins and needles sensation in your hand and fingers. It is also called median nerve compression. This median nerve supplies feeling and movement to your hand and all of your fingers except your pinky. The median nerve travels into the wrist through a narrow ligament opening called the carpal tunnel. Keeping the wrists flexed upward or repetitive hand motions, like while typing, can irritate the nerve and cause symptoms. A physical exam will indicate carpal tunnel syndrome and imaging tests can further show the damaged areas. Carpal tunnel may heal on its own or require conservative treatment like rest, wearing a wrist brace or taking anti-inflammatory medications. More severe nerve injury or failure to improve after 6 months may require a surgical carpal tunnel release procedure to decrease pressure on the nerve and restore function. Getting an accurate evaluation and appropriate care will help you get better as quickly as possible.
Symptoms are pretty consistent with carpal tunnel syndrome and usually occur slowly over a long period of time. The first thing you might notice is that your hands may fall asleep and tingle or feel numb at night or in the morning. Holding your hands by your sides and not over your head or shaking out your hands may temporarily make this feel better. You may have burning or tingling in your hands and fingers which can extend up your arm. Your hands and fingers may become weak and they may feel less coordinated. Repetitive motions may cause pain and cramping in the wrists and hands. Symptoms tend to worsen with more hand use and can progress to the point where the hands are virtually unusable. You can have permanent muscle and nerve damage with severe or untreated carpal tunnel syndrome. Well before this point you should seek medical attention.
You may not know exactly how you came to have carpal tunnel syndrome. Repetitive motions like typing or playing guitar or working with vibrating power tools can cause carpal tunnel syndrome. Anything that creates inflammation in the carpal tunnel can irritate the median nerve which slows nerve impulses to and from your hands to both weaken and decrease sensation. Conditions like obesity, hypothyroidism, diabetes and rheumatoid arthritis have a higher risk of carpal tunnel syndrome. Women are 3 times more likely to have carpal tunnel syndrome than men. Also, some families have smaller carpal tunnels which predisposes them to this condition.
Your doctor will perform a complete history and physical exam that will evaluate you for your source of your pain and discomfort. Your hand and finger nerve function will be evaluated along with and muscle strength and skin sensation. Your doctor will tap on your wrist to see if you have tingling and numbness with tapping called a “Tinel’s sign”.
Imaging tests can help your doctor identify injured areas of spinal bones and muscles. X-rays of the neck and shoulder may be used to look for fractures or other injuries around the brachial plexus. An ultrasound uses sound waves to create a picture inside of the carpal tunnel to look for swelling or inflammation. A computed tomography (CT) scan uses the electromagnetic energy of X-rays to provide a detailed look at the bony wrist anatomy and tissue around it. A magnetic resonance imaging (MRI) uses powerful magnets and radio waves to create a detailed picture of soft tissue of the muscles, soft tissue and nerves. Contrast dye may be used during both the CT scan and MRI to better evaluate the area of inflammation. Nerve conduction studies look for nerve damage by using electrodes to measure how quickly a nerve impulse is transmitted. An electromyogram uses needle electrodes to look for muscle damage. Evaluation of your strength and sensation may be monitored on a regular basis to look for improvement and imaging tests may be repeated as well.
Treatment of carpal tunnel syndrome depends on how far the syndrome has progressed. Mild cases will frequently improve within a few weeks or months. Resting or limiting the repetitive motions that caused the syndrome are important. Stretching, strengthening or “nerve gliding” exercises given to you by a physical therapist can help the nerve move more easily. Wearing a splint to immobilize the wrist while working or sleeping can take pressure off of the nerve. Over-the-counter medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) are NSAIDs (nonsteroidal anti-inflammatory drugs) that can decrease pain and swelling. Muscle relaxants and nerve pain medications can also be used. Steroid injections can decrease pain and inflammation. An occupational therapist can help you with skills to improve daily functioning when there is prolonged pain or weakness.
Surgery may be needed if your carpal tunnel syndrome is severe or if conservative treatments do not provide pain relief or improve symptoms after about 6 months of treatment. Carpal tunnel release surgery involves opening the compartment the median nerve travels through in the wrist. The transverse carpal ligament is cut to release pressure on the median nerve. This is a short procedure and you will be able to go home about an hour after surgery. Our neurologists can let you know if you are a good candidate for nerve surgery.
Carpal tunnel syndrome symptoms can be mild to debilitating. The Norelle Health neurosurgeons are highly trained and skilled in the diagnosis, management, and treatment of carpal tunnel syndrome. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).