Carpal Tunnel Syndrome

If you have carpal tunnel syndrome, you are not alone. This condition affects up to 6% of adults and can cause pain, numbness and weakness in your hand or wrist. Doctors are not sure what causes carpal tunnel syndrome, but certain repetitive movements such as typing or sewing may lead to the condition.

What is carpal tunnel syndrome?

Carpal tunnel syndrome happens when the median nerve is compressed (squeezed) by swelling around the nerve. The median nerve runs through the palm side of the hand, allowing you to feel sensation in your thumb, index, middle and ring fingers. 

Carpal tunnel syndrome can lead to weakness, pain, numbness and tingling on the side of the hand near the thumb, especially at night.   

What causes carpal tunnel syndrome?

Carpal tunnel syndrome can be caused by swelling in the wrist. That swelling might happen because of:  

• Diabetes
• Thyroid problems
• Fluid retention (such as during pregnancy)
• High blood pressure
• Autoimmune diseases like rheumatoid arthritis
• Injuries or trauma to the wrist

Repetitive motions can also cause or worsen carpal tunnel. These include: 

• Typing or using a computer mouse 
• Using hand or power tools that vibrate 
• Playing video games or musical instruments for long periods 

What are the symptoms of carpal tunnel syndrome?

Symptoms usually start slowly and get worse over time. They may include: 

• Tingling or numbness in your fingers, hand or wrist—often worse at night 
• Pain that starts in the hand and can move up the arm 
• Weak grip or trouble holding small objects 
• Muscle loss at the base of the thumb in more serious cases 
• Trouble feeling hot or cold temperatures in your fingers 

Sleeping with your wrists bent or fingers curled can make symptoms worse. 

Who is at risk for carpal tunnel syndrome?

Carpal tunnel syndrome is more common in adults than in kids. You may be at higher risk if you: 

• Use your hands for repetitive work or hobbies 
• Type for long periods without breaks 
• Use tools or machines that vibrate 
• Have diabetes, thyroid issues or nerve conditions 

Women are three times more likely to develop carpal tunnel than men, according to the National Institute of Neurological Disorders and Stroke. 

How is carpal tunnel syndrome diagnosed?

Your health care provider will ask about your symptoms and daily activities. They may press on your wrist to check for pain or numbness. 

They may also recommend tests like: 

• Nerve conduction studies to see how well your nerves are working 
• Electromyography (EMG) to measure your muscle response 

These tests help confirm whether your symptoms are from carpal tunnel syndrome or something else. 

What are some other conditions that look like carpal tunnel syndrome?

Spinal cord compression in the neck (cervical radiculopathy)

When a nerve is pinched in your neck, it can lead to nerve issues throughout your body. Cervical radiculopathy shares some symptoms with carpal tunnel syndrome. In fact, about half of people with spinal cord compression also have carpal tunnel syndrome. People with spinal cord compression may also have bladder and bowel control issues, numbness or pain in their legs or other issues related to nerve damage.

Arthritis

Any joint in your body can have arthritis, including your hands, wrists, and fingers. Arthritis develops with age and/or overuse, as cartilage breaks down in your joints. While carpal tunnel syndrome and arthritis can both be painful, arthritis doesn’t usually cause tingling or numbness. It is possible to have both conditions.

Tendonitis

Just like carpal tunnel syndrome, tendonitis (soreness in the tissues that connect your muscles to your bones) is often caused by overuse. Inflammation (swelling) of the tendons can create soreness and stiffness in the joint. But like arthritis, tendonitis does not usually cause numbness or tingling. 

Neuropathy

Neuropathy means you have nerve damage in your body. Neuropathy can be caused by age and/or conditions such as diabetes. People undergoing chemotherapy may also be at higher risk for neuropathy. 

Tingling, numbness, or pain may show up in the hands and fingers because of neuropathy. If you have neuropathy elsewhere in your body, carpal tunnel syndrome may be ruled out as the cause of your hand and wrist discomfort.

How is carpal tunnel syndrome treated?

Non-surgical treatment options

Treatment for carpal tunnel syndrome will be most effective if it is started as soon as possible. It includes these simple steps:

• Taking time to rest the hands and wrists throughout the day
• Avoiding activities that make your symptoms worse
• Applying ice or cold packs to reduce swelling
• Using wrist splints or braces, particularly at night
• Stretching and physical therapy
• Medication to reduce pain or inflammation, such as nonsteroidal anti-inflammatory drugs (NSAIDs)

Your provider may also recommend a corticosteroid injection to relieve pain and swelling. An ultrasound machine may be used to help your provider guide the injection and make sure it reaches the right area.

Surgical treatment options

If your symptoms don’t respond to other treatments or get worse, surgery may be the next step.

The goal of surgery is to get rid of pressure on the median nerve. The most common surgical treatment for carpal tunnel syndrome is called carpal tunnel release surgery. During the procedure your surgeon will cut through the transverse carpal ligament to create more space for the median nerve and surrounding tendons. During the healing process, the ligament tissues will gradually grow back together while allowing for more space for the nerve. 

This surgery can be done using two different methods:

• Open surgery - This procedure is done by making an incision to the palm of the hand over the carpal tunnel and cutting through the ligament to free the nerve from pressure.
• Endoscopic surgery - Performed using small incisions, a scope and a tube with a camera and a light. This allows for the surgery to be done with minimal invasiveness, less pain and shorter recovery time.

Your health care provider will help determine which surgical option is best for you.   

Whatever treatment path you choose, you should be able to keep working - but with a few changes. Your provider may recommend a brace, a change in posture or more breaks than usual. If you have surgery, an extended break from the repetitive motion may also be necessary while you heal.

You should also work with your provider to make sleep more comfortable. This may include changing your sleep position or wearing a brace or splint to bed. Talk to your provider about natural sleep aids.

What is recovery like following carpal tunnel syndrome surgery?

Relief of nighttime pain usually happens immediately, but numbness may take weeks or even months to go away. Any skin incisions will heal within a few weeks.

You may have pain, swelling and stiffness as you heal. Your surgeon will recommend that you slowly begin using your hand and wrist after the ligament has healed. It is important to carefully follow your provider’s directions.

Don’t wait to treat hand and wrist pain 

Ongoing pain, numbness or tingling in your hand or wrist could be carpal tunnel syndrome. Getting expert care early can help you avoid long-term nerve damage. 

Schedule an appointment with a Banner Health orthopedic specialist today.