Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

The carpal tunnel is a narrow, tunnel-like structure in the wrist, and is formed by wrist (carpal) bones. One of the important nerves for our hands, known as the median nerve, travels down from the forearm into the hand through the tunnel formed by the carpal bones. This nerve controls feeling in the palm side of the thumb, index finger, long fingers, and also controls the muscles around the base of the thumb. There are also tendons, called flexor tendons, which also travel through the carpal tunnel. Carpal tunnel syndrome is a common source of hand pain and numbness.

 

What Causes Carpal Tunnel Syndrome?

Carpal tunnel syndrome occurs when the median nerve is compressed in some way. There are many possible reasons why the median nerve may be compressed or infringed upon including heredity, certain kinds of labor which may stress the wrists, hormonal changes, age, or other medical conditions like arthritis and diabetes. In most cases, carpal tunnel syndrome is caused by a combination of the above factors. Carpal tunnel syndrome is almost never the result of a single factor, but anything that decreases the amount of space in the carpal tunnel, increases the amount of tissue in the tunnel, or increases the sensitivity of the median nerve can lead to carpal tunnel syndrome.

Get the Facts

  • Carpal tunnel syndrome is the most common nerve compression disorder of the upper extremity. This process affects 1 percent of the general population and 5 percent of the working population who must undergo repetitive use of their hands and wrists in daily living. Surgical treatment for carpal tunnel syndrome is the most frequent surgery of the hand and wrist, with 463,637 carpal tunnel releases annually in the United States. (Source: Plastic and Reconstructive Surgery:Volume 105(5)April 2000pp 1662-1665 The Incidence of Recurrence after Endoscopic Carpal Tunnel ReleaseConcannon, Matthew J. M.D.; Brownfield, Mona L. M.D.; Puckett, Charles L. M.D )
  • Carpal tunnel syndrome results in the highest number of days lost among all work related injuries. Almost half of the carpal tunnel cases result in 31 days or more of work loss. (Source: National Center for Health Statistics)
  • According to the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), repetitive strain injuries are the nation’s most common and costly occupational health problem, affecting hundreds of thousands of American workers, and costing more than $20 billion a year in workers compensation.

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Symptoms of Carpal Tunnel Syndrome

Most people experience symptoms in parts of the hand  controlled by the median nerve, i.e. the thumb, the index finger, the middle finger, and half of the ring finger. 

Frequently, symptoms will present themselves in both hands , but they are typically worse in one hand than the other. Many people first notice symptoms at night, because some people sleep with their wrist curled or flexed. It is not uncommon for people with carpal tunnel syndrome to wake up because of pain or numbness during the night.

Mild carpal tunnel symptoms most often affect the hand and sometimes the forearm, but they can spread up to the shoulder. Symptoms include numbness or pain in your hand, forearm, occasional tingling like a “pins-and-needles” sensation, periodic aching pain in your forearm between your elbow and wrist, or even stiffness in your fingers when you get up in the morning. Many people also report feeling weakness in their hands and are unable to pinch an object between their thumb and forefinger, use their thumb while doing simple tasks like using a screwdriver, or even brush their hair or hold a spoon.

wrist pain office work

Treatment

Without treatment or some kind of intervention, carpal tunnel syndrome will most likely continue to get worse. If caught early there are many “at-home” treatments that can help control and treat symptoms, while preventing the condition from worsening. Some common interventions include:

  • Bracing or splinting. These will be most likely be worn at night in order to keep the wrist in a neutral position, which will help prevent nightly irritation that can occur when wrists are curled during sleep. Splints can also be worn during daytime activities that aggravate your condition.
  • Medications. Simple, over-the-counter medications like anti-inflammatory drugs (NSAIDs) can help relieve and control the pain of mild carpal tunnel syndrome.
  • Activity changes. If the nature of your job or work requirements aggravates or contributes to your symptoms, changing or modifying jobs may slow or stop progression of the disease, as well as changing the pattern and position of hand use.
  • Steroid injections. A corticosteroid injection will often provide relief, but it is possible that this relief will  be temporary and that symptoms may return.

Surgical Treatment

Carpal tunnel surgery is considered when patients have failed to find substantial relief from the symptoms of carpal tunnel syndrome with less invasive treatments and remedies. If symptoms haven’t improved after several weeks to months of nonsurgical treatment,  most doctors agree that you are likely experiencing ongoing symptoms but no sign of nerve damage. When doctors and orthopedic surgeons suspect nerve damage,  surgery becomes a more urgent option. Surgery is also considered when any severe symptoms restrict normal daily activities, such as:

  • Persistent loss of coordination or numbness in the fingers or hand.
  • Decreased strength in the thumb.
  • Regularly interrupted sleep because of  severe pain.
  • Damage to the median nerve or a risk of damage to the nerve.

Read more here: AAOS