What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a medical condition associated with numbness, pain, and weakness in the wrists and hands. It results from compression of the median nerve, which provides feeling and muscle mobility to the thumb, index, middle, and ring fingers, but not the pinky. The carpal tunnel is the median nerve’s pathway through the wrist into the hand, named for the small and irregularly shaped carpal bones that line the tunnel. It also contains ligaments and tendons, which reinforce and strengthen the wrist-hand connection. Carpal tunnel syndrome is estimated to affect as much as five percent of the adult American population.

If left untreated, carpal tunnel syndrome can, in extreme cases, lead to nerve damage and permanent disability. Let the orthopedic specialists and other medical practitioners at Baptist Health lend a hand if you or a family member is dealing with this condition.

What Are the Symptoms of Carpal Tunnel Syndrome?

Carpal tunnel syndrome is marked by a wide range of symptoms. These may come on gradually, worsening over time. Early symptoms include:

• Pain or a tingling feeling in the fingers
• Hand and wrist numbness, first at night but later during daytime
• A loss of finger feeling
• Difficulty in holding objects, such as books, utensils, hand tools, and pens or pencils
• An inability to complete tasks, such as gripping a steering wheel to drive or typing on a keyboard.

More serious symptoms include:

• Growing weakness of the hand
• Loss of fine motor control
• Dropping objects involuntarily.

You may notice increased pain or discomfort in your wrist at night. Many people sleep in a position that puts pressure on their wrist, causing pain and numbness. This pain often makes it difficult to fall asleep or stay asleep throughout the night. Daytime symptoms usually occur when you perform activities with your wrist curved either toward you or away from you. One example is driving for a long time. When you feel carpal tunnel symptoms, shaking your hands may help reduce your discomfort.

Any repetitive action or injury that irritates or places pressure on the median nerve can lead to carpal tunnel syndrome. This includes both dramatic single causes, such as wrist fractures, or more subtle multiple causes, such as the use of the hands in physically demanding tasks combined with other medical or anatomical factors.

Risk factors that increase the likelihood of carpal tunnel syndrome include:

• Job requirements, such as the use of vibrating tools or assembly-line equipment
• Wrist or hand injuries, including fractures and dislocations
• Being overweight
• Medical disorders, such as diabetes, which cause nerve damage
• Rheumatoid arthritis and other inflammatory conditions
• The use of medications such as anastrozole, a drug for breast-cancer patients
• Bodily fluid retention, which can increase pressure on the median nerve
• Sex, because women are more susceptible than men to developing carpal tunnel syndrome.

Risk factors that increase the likelihood of carpal tunnel syndrome include:

• Body structure—A wrist fracture, a dislocation, or arthritis can make it hard to move your hand. This shrinks the space in your carpal tunnel, which can make you more likely to develop carpal tunnel syndrome.
• Job conditions—Workplace requirements, such as the use of vibrating tools or assembly-line equipment, can lead to carpal tunnel syndrome. People who work with their hands or use them repetitively are at risk for carpal tunnel syndrome.
• Conditions that Damage Nerves—Medical disorders, such as diabetes, cause nerve damage. The nerve damage can lead to carpal tunnel syndrome.
• Gender—Women usually have smaller carpal tunnels and, therefore, are more susceptible than men to developing carpal tunnel syndrome.
• Being overweight—Obesity can put extra pressure on the carpal tunnel leading to inflammation and nerve damage.
• Age—Older people are more likely to develop carpal tunnel syndrome because the carpal tunnel narrows over time.
• Inflammatory conditions—Rheumatoid arthritis and other inflammatory conditions can lead to carpal tunnel syndrome because inflammation causes tissue swelling, which puts pressure on the carpal tunnel.
• Medications—The use of medications, such as common drugs for breast cancer patients, increase your risk for carpal tunnel syndrome. These medications increase the risk of inflammation and swelling.
• Bodily fluid retention— Body fluid retention can increase pressure on the median nerve, which can lead to carpal tunnel syndrome.
• Medical History—You are at an increased risk for carpal tunnel syndrome if you have experienced kidney failure, thyroid disorders, menopause, or lymphedema.

How Is Carpal Tunnel Syndrome Diagnosed?

Diagnosing carpal tunnel syndrome is a multi-step process. Your physician will start by giving you a physical exam, asking questions about your symptoms, and recording your medical history. He or she may then test for carpal tunnel syndrome using one or more of these methods:

• Tinel’s sign: Tinel’s sign involves testing the fingers for physical sensation by tapping the wrist where the carpal tunnel and median nerve are located.  
• Wrist-flexion test: Patients with carpal tunnel syndrome cannot bend their hands forward at the wrist for any length of time without developing a tingling sensation or loss of feeling. During a wrist-flexion test, your physician will time how long it takes for you to exhibit these symptoms with your wrist bent. The sooner tingling or numbness occurs, the more likely you are to have carpal tunnel syndrome. This method is also called the Phalen test.
• Electromyography (EMG) and nerve-conduction study: Electromyography is a medical test of electrical activity in the muscles and nerves. EMGs can be used to determine the effectiveness of the median nerve in delivering the brain’s electrical impulses to the muscles and nerves of the hand.
• X-rays: X-rays can provide insight on the presence of arthritis or trauma in the wrist, which can be indicators of carpal tunnel syndrome.

How Is Carpal Tunnel Syndrome Treated?

There are both surgical and non-surgical treatments for carpal tunnel syndrome. Non-surgical treatments are typically utilized with less serious cases, while surgery is limited to those situations where carpal tunnel syndrome impedes the operations of daily living.

Non-surgical Treatments

Non-surgical treatments include wearing a wrist splint, receiving cortisone injections, and taking ibuprofen or a similar anti-inflammatory drug. You can also lessen or at least control symptoms by changing the behaviors that have led to a compressed median nerve (for example, modifying work habits to reduce stress on your wrists and hands).

Carpal Tunnel Surgery

Surgery is the primary alternative when non-invasive treatments fail to provide relief. The goal of surgery is to expand the carpal tunnel, thereby relieving pressure on the median nerve, by cutting the transverse carpal ligament. The latter is one of the carpal tunnel’s structural elements, but also serves to reinforce any pressure being applied to the median nerve when the tunnel is otherwise constricted. Carpal tunnel surgery is typically performed on an outpatient basis, with a full recovery time of up to four to six weeks.

Carpal tunnel syndrome treatment is either nonsurgical or surgical. Doctors usually prefer to start with nonsurgical treatment options, then move to surgical options, as necessary.

Nonsurgical treatment options:

• Steroid injections—These injections can help reduce swelling and decrease nerve pain. Doctors use a small needle to inject the steroid medication into the carpal tunnel in your wrist. The relief is sometimes temporary.
• Splinting or bracing—A brace or splint helps keep your wrist from moving, especially at night. You may also want to wear a splint or brace during the day to reduce stress on your wrist. You do not need to wear a brace or splint all the time.
• Lifestyle changes—Altering how you perform daily activities at work or play may help reduce symptoms and slow the progression of the condition.
• Nonsteroidal anti-inflammatory drugs (NSAIDs)—These medications help reduce inflammation and pain. Ask your doctor for more information about the potential benefits of these medications.
• Nerve gliding—Some people benefit from hand exercises. Your doctor may recommend exercises that give your median nerve more freedom to move inside your carpal tunnel.

Surgical treatment options:

• Open carpal tunnel release—Your doctor will make a small cut on your hand, allowing them to see inside your hand and wrist. Then, your doctor can perform surgery to increase the size of your carpal tunnel. The larger your carpal tunnel, the less pressure on your median nerve.
• Endoscopic carpal tunnel release—In endoscopic surgery, your doctor makes one or two small incisions to the skin and then uses a special device affixed with a camera to see inside your hand. Your doctor uses a special medical knife to separate the transverse carpal ligament.

Carpal tunnel recovery time varies by person and treatment needed. Carpal tunnel surgery is usually an outpatient treatment. After surgery, recovery time is generally from 4 to 6 weeks.

With proper treatment, the impact of carpal tunnel syndrome can be lessened or controlled. Surgical treatments for severe cases are often successful, with more than 90 percent of patients reporting reduced symptoms and improved functionality.

Learn More About Carpal Tunnel Syndrome Treatment from Baptist Health

If you’re experiencing the symptoms of carpal tunnel syndrome, visit your Baptist Health physician.