Got That Tingly Feeling? It May Be Carpal Tunnel Syndrome

The carpal tunnel is a narrow passageway for nerves and tendons located in the wrist. It is comprised of ligament, tendons, and bones. The carpal tunnel also includes an important nerve known as the median nerve, which leads from the forearm into the hand.

Too much pressure on the median nerve can cause a group of symptoms (or syndrome), including pain, weakness, and numbness in the hand, wrist, and arm. The condition is known as carpal tunnel syndrome. Because it involves the nerve, carpal tunnel syndrome is considered a problem of the nervous system or neurologic disorder. 

Symptoms 
“Many people with carpal tunnel syndrome describe having a tingling, pain and a burning sensation in the fingers, hand, wrist, and arm,” says Summit Medical Group hand surgeon Reza Momeni, MD, FACS. “Some people experience numbness in the thumb, index, other fingers, and palm,” adds Dr. Momeni. “Even though there might be no visible signs of inflammation, the hands can sometimes feel swollen and clumsy. In severe cases, carpal tunnel syndrome makes it difficult to grip objects. Some people with the condition even find it difficult to distinguish between hot and cold.”

Symptoms usually begin in the hand that is used most frequently (the dominant hand). They typically first occur in one or both hands during the night; but if they worsen, symptoms can occur intermittently both in the daytime and nighttime.  In most patients, both hands will eventually be affected.

Causes
Possible causes of carpal tunnel syndrome are:

• Having a small wrist and carpal tunnel, which increases the tendency for pressure on the nerve
• A wrist injury such as a fracture or sprain that causes swelling
• Excessive wear of and other problems with the wrist joint
• A cyst or tumor that presses on the median nerve
• Overuse and poor positioning of the wrist at work
• Using vibrating hand tools repeatedly
• Rheumatoid arthritis
• An overactive pituitary gland
• An underactive thyroid or (hypothyroidism)
• Retaining fluid during pregnancy or menopause

Risk 
Carpal tunnel syndrome usually occurs only in adults. Three times more women than men develop the condition. People with diabetes and other diseases that affect the nerves also are risk for carpal tunnel syndrome. Assembly line workers and people who use their hands to perform repetitive motions are at high risk for it.

Diagnosis
“Diagnosing and treating carpal tunnel syndrome in its early stages is important for preventing permanent nerve damage,” says Dr. Momeni.

If you are having symptoms of carpal tunnel syndrome, your doctor will review your medical history and ask questions about your activities to find out if you are at risk for the condition. He or she will then carefully examine your hands, arms, shoulders, and neck. Your doctor will check your wrist to find out if it is tender, swollen, warm, or bruised. He or she also will check to see if your fingers are numb and whether your hands are weak.

Your doctor also might tap, press, and flex your wrist to see if your fingers tingle or if you feel a shock. He or she will likely ask you to do other movements that can prompt symptoms of carpal tunnel syndrome.

In some cases, doctors use nerve conduction studies (or electrodiagnostic testing) to transmit impulses and measure their speed through the median nerve. Ultrasound imaging can show whether the median nerve responds as it should to stimulation.

Nonsurgical Treatment
“Treatment for carpal tunnel syndrome always begins with resting the hand and wrist to reduce swelling inside the wrist,” says Dr. Momeni. “During that time,” he emphasizes, “it’s important to avoid all activities that make the symptoms worse.” A splint can help keep the wrist from moving so that it can rest fully. Ice packs, anti-inflammatory medications such as aspirin and ibuprofen, diuretics, and corticosteriods can be used to reduce pain and swelling. If you need medication, your doctor will recommend what might work best for you.  For some patients, a steroid injection can be used to reduce inflammation.

Surgical Treatment
Rest, splinting, and medications do not always alleviate the pressure on the median nerve. For this reason, people with chronic or severe symptoms often need carpal tunnel release surgery. There are 2 types of carpal release surgeries — open release andendoscopic release. Both procedures are performed in the outpatient surgery setting.

• In open release surgery, your surgeon will make an incision up to 2 inches in the wrist. He or she will then cut the carpal ligament to make more room in the carpal tunnel for the nerve
• For endoscopic release surgery, your surgeon will make one small (~1/4 inch) incision in your wrist and palm. He or she will then insert a tube with a camera to find the carpal ligament. Once the ligament is cut to release the pressure on the nerve, your surgeon will close the small incisions with sutures. Benefits of endoscopic carpal release surgery include quicker recovery, less pain, and smaller scars compared with open release surgery

 “If you need surgery for carpal tunnel syndrome,” says Dr. Momeni, “the good news is that carpal release is one of the most common procedures in the United States.  It’s especially effective for patients who have the treatment early, before the median nerve is permanently damaged.  Most patients who have the surgery recover well and are pleased with the results. In addition, patients who have carpal release surgery rarely experience recurrent symptoms.”