Carpal Tunnel Syndrome
Carpal tunnel syndrome is a condition in which compression of the median nerve in the wrist causes pain, tingling, numbness or weakness in the palm side of the hand and fingers. More severe cases of the condition can lead to permanent muscle damage.
What causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome is caused by a compression of the median nerve, which travels from the wrist into the hand in a narrow space called the carpal tunnel, surrounded by ligaments and bone. Anything that causes swelling in this area can cause compression of the nerve. This occurs most often in those who perform certain repetitive activities for work or leisure that involve the wrist and hand, including assembly line work, typing, writing, painting, sewing, using hand tools, playing musical instruments, or playing certain racket sports. There are also a number of medical conditions that make individuals more likely to suffer from the condition, including osteoarthritis, rheumatoid arthritis, diabetes, high blood pressure, and other metabolic disorders. Bone fractures within the wrist or hand also make it more likely that carpal tunnel syndrome will develop. Women are three times more likely than men to develop the condition.
What are the symptoms of Carpal Tunnel Syndrome?
The primary symptoms of carpal tunnel syndrome include pain, tingling, numbness, burning or weakness in portions of the hand, fingers and wrist. Symptoms are most likely to be felt near the thumb and the adjacent two fingers and in the palm of the hand. Pain may extend up through the wrist and into the forearm to the elbow. Carpal tunnel syndrome may cause difficulty with some fine motor skills involving the fingers and may make it difficult to grip or grasp objects. Development of symptoms is often gradual and may first be felt in the morning, after sleeping on wrists or flexing them in the middle of the night.
How is Carpal Tunnel Syndrome diagnosed?
A medical professional will take a complete medical history and will ask questions related to when the symptoms began, what types of activities or movements increase or decrease symptoms, what type of work or leisure activities are regularly engaged in, and what the relative severity of the symptoms is. A physical exam will include checking for numbness, weakness, tenderness or pain in certain areas of the hand and wrist, checking the strength of the hand grip, tapping directly on the median nerve to see if it causes pain in the fingers (Tinel test), and performing the Phalen test (bending the wrist all the way forward for one minute to see if it causes numbness or weakness). Other tests include x-rays, to rule out other causes of symptoms, as well as tests to check the condition of the nerves, including electromyography and nerve conduction velocity tests.
When should I seek care for Carpal Tunnel Syndrome?
If you have pain, tingling, numbness or weakness in your hand or fingers that does not improve with a short period of rest, avoidance of certain activities, application of ice and taking nonsteroidal anti-inflammatory medications, you should seek medical advice. If the symptoms increase or become severe, or you experience numbness or weakness that impedes regular activities, you should seek prompt medical attention. Failure to treat carpal tunnel syndrome and to avoid activities that cause the condition can lead to permanent nerve damage.
What will the treatment for Carpal Tunnel Syndrome consist of?
Conservative treatments for carpal tunnel syndrome include wearing a splint or brace to take pressure off of the nerve, avoiding or changing the way you perform certain activities, or using ergonomic aids to reduce pressure on the wrist while performing activities. Changes in the work environment are especially useful in reducing stress on the median nerve in the wrist and include ergonomic changes in how the computer is used, how your body is situated when sitting at a desk or performing routine tasks, and modifying other activities that affect the positioning of the arms, wrist and hands. Application of ice and heat may help ease symptoms of carpal tunnel syndrome, and nonsteroidal anti-inflammatory medications and corticosteroid injections are also helpful. Once the primary symptoms have diminished, physical therapy, including stretching and strengthening exercises, are often recommended. A surgical procedure can be performed (carpal tunnel release) to cut the ligament that presses on the median nerve in more severe cases. Physical therapy is needed after surgery to restore strength and flexibility in order for a full recovery to be achieved.
Which muscle groups/joints are commonly affected by Carpal Tunnel Syndrome?
Carpal tunnel syndrome results from compression of the median nerve which runs down the arm, through the wrist and into the hand. Most symptoms are felt in the wrist and on the palm side of the hand, thumb and fingers.
What type of results should I expect from the treatment of Carpal Tunnel Syndrome?
Most treatments will improve the symptoms associated with carpal tunnel syndrome but may not work to completely alleviate the condition. If modifications are not made in how repetitive activities are performed, it is likely that symptoms will recur. Surgery is usually recommended in about half of the cases of the condition and is generally successful at alleviating symptoms when followed by a rehabilitation program, assuming that permanent nerve damage did not already occur. It may take a number of months after surgery for a full recovery to be achieved.