Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common source of hand numbness and pain. It is more common in women than men. It is caused by increased pressure on median nerve at the carpal tunnel. The actual cause is unknown in most people Carpal tunnel syndrome is more common in women. In women, the swelling that occurs during pregnancy may cause symptoms, but those will frequently go away after delivery. Carpal tunnel syndrome becomes more common as we grow older and seems to affect people with certain medical conditions such as diabetes, thyroid conditions and rheumatoid arthritis more frequently.

Symptoms: Carpal tunnel syndrome symptoms usually include pain, numbness, tingling, or a combination of the three. The numbness or tingling most often takes place in the thumb, index, middle, and ring fingers. The symptoms usually are felt during the night but also may be noticed during daily activities such as driving or reading a newspaper or holding a phone, reading or driving. Initially symptoms come and go, but over time they may become constant. Patients may sometimes notice a weaker grip, occasional clumsiness, and a tendency to drop things. In severe cases, sensation may be permanently lost and the muscles at the base of the thumb.

Diagnosis: A detailed clinical exam and symptoms history it is important to request. A nerve conduction study (NCV) and/or electromyogram (EMG) may be done to confirm the diagnosis of carpal tunnel syndrome as well as to check for other possible nerve problems.

Treatment: Symptoms may often be relieved without surgery. Keep the wrist splinted in a straight position may help reduce pressure on the nerve. Wearing wrist splints at night may relieve the symptoms that interfere with sleep. Splints can also be worn during activities. A steroid injection into the carpal tunnel may help relieve the symptoms by reducing swelling around the nerve.

When symptoms are severe or do not improve, surgery may be needed to make more room for the nerve. Pressure on the nerve is decreased by cutting the ligament that forms the roof (top) of the tunnel on the palm side of the hand. Techniques for carpal tunnel release for this surgery can be different, but the goal is the same: to open the tunnel and decrease pressure on the nerve. The numbness and tingling may disappear quickly or slowly. It may take several months for strength in the hand and wrist to return to normal. Carpal tunnel symptoms may not completely go away in severe cases.