What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome causes numbness, pain and sometimes tingling in the hand and forearm. This condition is manifested when the median nerve in the hand is damaged or compressed on its way through to the wrist.

When the median nerve travels down the upper arm, across the elbow and into the forearm it then passes through the narrow carpal tunnel at the wrist on its way to the hand and fingers. It separates into smaller nerves along the way, particularly once it reaches the palm. These nerves allow for feeling in the thumb, index finger, middle finger and half of the ring finger on the side of the thumb.

The median nerve is also connected to the muscles around the base of the thumb. The nine tendons that bend the fingers and thumb also travel through the carpal tunnel with the nerve. These tendons are called flexor tendons because they flex the fingers and thumb.

What Causes Carpal Tunnel Syndrome?

• Heredity – It can be a trait that tends to run in families. 
• Repetitive hand use – Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist causing swelling that puts pressure on the nerve.
• Hand and wrist position – Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of  time can increase pressure on the nerve.
• Pregnancy – Hormonal changes during pregnancy can cause swelling that results in pressure on the nerve. Women are three times more likely than men to have a Carpal Tunnel Syndrome diagnosis.

What are the Symptoms of Carpal Tunnel Syndrome?

Symptoms of Carpal Tunnel Syndrome may include: 

• Numbness, tingling, burning and pain—primarily in the thumb, index, middle and ring fingers. This often wakes people up at night.
• Occasional shock-like sensations that radiate to the thumb and index, middle and ring fingers.
• Weakness and clumsiness in the hand- This may make it difficult to perform fine movements such as buttoning your clothes.
• Dropping things- Due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space).

In most cases, the symptoms of Carpal Tunnel Syndrome begin gradually WITHOUT A SPECIFIC INJURY. Many find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods  of time.

Nighttime symptoms are quite common. Because many people sleep with their wrist bent, symptoms may awaken you from sleep. During the day, a person may notice the symptoms occurring when holding a certain position for a long period of time. For example, holding the wrist bent forward or backward while reading a book, typing, or using a phone for too long.

An automatic reaction to the discomfort is moving or shaking the arms and hands. People often notice this action helps relieve symptoms. 

To avoid permanent damage, though, don’t ignore the symptoms of Carpal Tunnel Syndrome. It is important to have the diagnosis confirmed by a qualified physician, preferably a neurologist.

How is Carpal Tunnel Syndrome Diagnosed?

To determine a diagnosis, your provider will first conduct a physical exam. Neurology Associates in Dulles and Lansdowne Virginia has experience in diagnosis and treatment of Carpal Tunnel Syndrome. Dr. Dulai will test the feeling in the fingers and hand by bending the wrist and tapping on the nerve, manipulating the arm and hand to determine if there is anything out of the ordinary. It is possible to trigger symptoms to confirm the syndrome is taking place.

X-rays of the affected wrist may be recommended to exclude other causes of wrist pain, such as arthritis or a fracture. However, x-rays are not helpful for diagnosis of Carpal Tunnel Syndrome as this is a disorder of soft tissue, not bone. Tests that are appropriate include:

• Ultrasound – The doctor may suggest an ultrasound to get a good picture of the bones and nerves and help determine if the median nerve is being compressed.
• Electromyography – This test determines the tiny electrical discharges produced in muscles. To do this test, your provider inserts a thin needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. This test is useful in identifying what, if any, damage to the muscles controlled by the median nerve has occurred. It is also used to rule out other conditions.
• Nerve conduction study – in this test two electrodes are taped to the skin and a small amount of current is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose the condition and rule out other conditions.

What is the Treatment for Carpal Tunnel Syndrome

Treatment for Carpal Tunnel Syndrome should be started as early as possible. In the beginning stages, limit repetitive actions by taking more frequent breaks to rest the hands. Avoid elective activities that make symptoms worse, for example recreational sports that require using hand and wrist action. Apply cold packs to forearms, wrists and hands to reduce swelling.

Other options that may help include splinting the wrist and hand and taking anti-inflammatory medicines, such as NSAIDS.

These at-home steps are more likely to help if you are having only mild to moderate symptoms that come and go for less than a few months. More severe cases may require the intervention of a physician.

Is Surgery Necessary to Relieve Carpal Tunnel Syndrome?

Surgery may be appropriate if symptoms are severe enough that they interfere with everyday life, cause extreme pain, and/or do not respond to other treatments.

The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve. Surgery may be performed by either of two different techniques. In endoscopic surgery the surgeon uses a telescope-like device with a tiny camera attached to it (endoscope), to see inside the carpal tunnel. Your surgeon cuts the ligament through 1 or 2 small incisions in the hand or wrist.

Endoscopic surgery may result in less pain in the first few days or weeks than it would with open surgery. 

In open surgery the surgeon makes an incision in the palm of the hand and cuts through the ligament to free the nerve. During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve. This internal healing process takes several months, but the skin heals in a few weeks

Your doctor will most likely encourage the use of the hand after the ligament heals. You can then gradually resume normal use while initially avoiding forceful hand motions or extreme wrist positions. Soreness or weakness may take several weeks or months to resolve following surgery. 

Visit Neurology Associates to Discuss

Contact Dr. Dulai’s office and schedule an appointment to determine if you have Carpal Tunnel Syndrome. After giving a diagnosis, the doctor will provide treatment options and if needed will discuss the risks and benefits of surgery. 

For more information about Carpal Tunnel Syndrome, read the NIH fact sheet.