Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a common condition that causes pain, numbness and tingling in the hand and wrist. This is caused when the tunnel becomes narrow or when the tissues surrounding the flexor tendons become inflamed and swell causing pressure on the median nerve.

Causes and risk factors

  • Heredity
  • Repetitive hand use
  • Doing activities with extreme flexion or extension of the hand and wrist
  • Pregnancy or other conditions that cause your body to hold onto fluid
  • Diabetes
  • Rheumatoid arthritis
  • Wrist injuries

Symptoms

  • Tingling and numbness in fingers – primarily in the thumb, index, middle, and ring fingers.
  • Pain or tingling that travels up the arm toward the shoulder.
  • Lack of strength in grip and finger coordination – this may make it difficult to participate in normal activities such as buttoning your shirt.
  • Dropping things due to weakness or numbness
  • Nighttime symptoms are very common and may awaken you from sleep.

Moving or shaking your hands can sometimes help to relieve symptoms.

Diagnosis

Most people that have carpal tunnel will notice that their symptoms gradually worsen over time. It is important to be evaluated in the early stages to slow or stop the progression of carpal tunnel syndrome. An orthopedic surgeon will examine your hand and wrist and test for nerve damage. An EMG or Nerve Conduction Study will help confirm if there is too much pressure on the nerve. Sometimes an ultrasound, x-ray or MRI will also be ordered. These tests help your doctor determine the severity of your carpal tunnel syndrome.

Treatment

Nonsurgical treatments include rest, ice, wrist splints, nonsteroidal anti-inflammatory drugs (NSAIDS), or steroid injections. Other options may include modifying your activity to reduce symptoms and slow the progression of the disease.

If conservative treatment options do not relieve your pain, your orthopedic surgeon may recommend surgery. A carpal tunnel release surgery increases the size of the carpal tunnel and decreases pressure on the nerve. This procedure can either be performed using endoscopic surgery or with traditional open surgery. There are risks and benefits to both and your doctor will discuss both with you. Some patients who choose endoscopic carpal tunnel release may be eligible to utilize wide-awake local anesthesia rather than general anesthesia.

Recovery

After surgery you may be encouraged to do the following:

  • Elevate your hand above your heart and move your fingers to reduce swelling and prevent stiffness.
  • Ice the surgical site for a given amount of time, a few times a day.
  • You may need to wear a splint or wrist brace for several weeks.
  • Follow your doctor’s specific instructions on when it’s okay to return to work and whether you will have any restrictions on your work activities.
  • If you experience increased pain and weakness for more than two months following surgery, you may be referred to a hand therapist to help improve your recovery.

It is likely that surgery will improve your previous symptoms, but recovery can be gradual, and in some cases, can take up to one full year. Other factors that can contribute to longer recovery times are preexisting conditions, such as arthritis or tendonitis, which could also be contributing to pain and stiffness.

Carpal tunnel surgery aftercare and milestones you can expect to meet with carpal tunnel release can vary. Click here for one example of how your recovery could progress.