CARPAL TUNNEL SYNDROME: Signs, Symptoms, Causes and Treatments

DAVID WETHERHOLD,
MD CHIEF MEDICAL INFORMATION OFFICER 
SCRIPPS HEALTH



Common hand and wrist problem can be prevented and treated.

You wake in the night with a painful tingling sensation in your fingers — or no sensation at all.

As your condition advances, you have trouble holding the steering wheel to drive or typing on your computer keyboard. You experience weakness in your hand and begin dropping small objects.

If these signs and symptoms sounds familiar, you may have carpal tunnel syndrome, which is a very common problem. The condition is often associated with overuse of the hands and wrist and other factors. “It’s important to get evaluated if you develop symptoms of carpal tunnel syndrome to get a diagnosis and rule out any other problem,” says Lorenzo Pacelli, MD, an orthopedic surgeon at Scripps Clinic Carmel Valley and Scripps Clinic Torrey Pines. “Talk to your doctor if your condition is interfering with your sleep at night and your day-to-day activities. “Carpal tunnel syndrome is not something you want to ignore because if it goes untreated for a period of time, it can cause permanent damage to the nerve and use of your hand,” Dr. Pacelli says.

What is carpal tunnel syndrome?
Picture a tunnel running from your forearm through the center of your wrist. This narrow passage is called the carpal tunnel. Your median nerve, which supplies feeling and function to your thumb and first three fingers, runs through it. Carpal tunnel syndrome occurs when the median nerve becomes compressed, either by a swollen ligament or inflammation of the tendons within the tunnel. Pressure on the nerve may cause numbness and tingling and pain in the wrist, hand or fingers (excluding your little finger).

What are the early signs?
Early signs of carpal tunnel syndrome often involve tingling or mild pain in the hands or wrist, usually during the night. “As the condition worsens, tingling may happen during the day. Hand weakness may make it hard to grasp small objects and perform other activities,” Dr. Pacelli says. Who gets carpal tunnel syndrome — and why? Carpal tunnel syndrome affects up to 5% of the adult population in the United States. The condition is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel. Age, heredity and gender are among several risk factors. Carpal tunnel syndrome is most often diagnosed between the ages of 40-60. Women are three times more likely than men to experience the condition. Fluid build-up in the ligaments during pregnancy, menopause and before menstruation may trigger some cases. Inflammatory conditions, such as rheumatoid arthritis, wrist injury or dislocation, diabetes and obesity are other risk factors. Work activities that involve repetitive use of the wrist or hand may also contribute to nerve compression. Treatments for carpal tunnel syndrome Treatments range from rest to over-the-counter medication to physical therapy and surgery. A non-surgical approach may be all you need to get better. “Resting the affected area for a period may be enough to ease inflammation. Also helpful is taking breaks more often or doing less of the activity that is causing you pain,” Dr. Pacelli says. Next steps – if needed – may include using a splint to sleep, physical therapy and anti-inflammatory medication. “Sometimes we’ll do a cortisone injection to help reduce the swelling around the tendon to help to take pressure off the nerves,” Dr. Pacelli says. Physical therapy can help restore functional mobility.

At Scripps, physical therapists or occupational therapists provide hand therapy services. Yoga is an alternative therapy that has been shown to reduce pain and improve grip strength. When is surgery an option? If pain or numbness are severe or do not improve with non-surgical treatments, surgery is an option. Carpal tunnel release is one of the common procedures in the United States. In this procedure, the surgeon cuts through a ligament in the wrist to relieve pressure on the median nerve. The procedure is done with numbing medicine. “It’s a very effective procedure. Recovery is two to three weeks. The hand stays a little weak for up to a month. But most of the time, the symptoms go away within the first week of the surgery,” Dr. Pacelli says. 4 tips for reducing risk of carpal tunnel syndrome

The following tips can help reduce your risk of carpal tunnel syndrome:

1. Change the way you work
Make adjustments to promote correct posture and positioning and reduce repetitive stress. As you work, your wrists should be in the same position as they are when you dangle your arms at your sides.

2. Take frequent breaks from repetitive tasks
Avoid excessive exertion of your hand and wrist muscles. Minimize vibration from machines or tools.

3. Stretch your wrists before you start tasks and during breaks.
Learn to do isometric and stretching exercises to strengthen the muscles in the wrists and hands. “Do exercises where you stretch your fingers and redistribute swelling around the tendons,” Dr. Pacelli says. “Wear protective braces if you are susceptible to carpal tunnel syndrome.”

4. Simple wrist exercises for carpal tunnel syndrome
There are simple wrist exercises that are designed to help prevent and treat carpal tunnel syndrome. A physical or occupational therapist can help you strengthen your hand and wrist. They can teach you how to do specific hand stretching exercises.