Do you have frequent burning, tingling or itching numbness in the palm of the hand and the fingers (especially the thumb and the index and middle fingers)? According to the American Academy of Orthopaedic Surgeons, these are all symptoms of carpal tunnel syndrome. But what exactly is this condition?
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome is caused when pressure is placed on the median nerve, one of the major nerves that runs from the arm to the wrist, and which passes through a narrow opening called the carpal tunnel. You may experience numbness, weakness, tingling sensations or even pain. This is called carpal tunnel syndrome.
This sensation may happen when holding a steering wheel, grasping a phone or using a keyboard. Sometimes the numbness can wake you up at night, and make you feel like you need to shake your hand to stop the tingling. The weakness and numbness in your hand may make you drop objects. As the condition worsens, the numbness may become constant. Repetitive work on an assembly line or working with vibrating tools may cause the condition or worsen existing nerve damage.
“It doesn’t take a lot of pressure to impact the nerve,” according to Angela Polmateer, a certified hand therapist at Franciscan Health Physical, Occupational & Speech Therapy Lafayette.
Am I at Risk for Carpal Tunnel Syndrome?
- Heredity: The carpal tunnel may be smaller in some people or there may be anatomic differences that change the amount of space for the nerve—and these traits can run in families.
- Repetitive hand use: Repeating the same hand and wrist motions or activities over a prolonged period may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
- Hand and wrist position: Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period can increase pressure on the nerve.
- Pregnancy: Hormonal changes during pregnancy can cause swelling.
- Health conditions: Diabetes, rheumatoid arthritis and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.
Why Does Pregnancy Increase My Risk of Carpal Tunnel Syndrome?
Carpal tunnel syndrome is more common in women. Increased fluid retention in pregnancy and menopause may put additional pressure on the nerve in the wrist. However, carpal tunnel syndrome that is associated with pregnancy often improves on its own after the pregnancy.
What Are Symptoms of Carpal Tunnel Syndrome?
There are several symptoms that patients should be aware of. Carpal Tunnel symptoms can include:
- Numbness, tingling, burning and pain—primarily in the thumb and index, middle and ring fingers
- Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
- Pain or tingling that may travel up the forearm toward the shoulder
- Weakness and clumsiness in the hand—this may make it difficult to perform fine movements such as buttoning your clothes
- Dropping things due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)
The key is not to wait before seeking help when symptoms arise.
Kelly Graner, MD, an orthopedic surgeon specializing in hand surgery at Franciscan Physician Network Orthopedic Specialists Indianapolis, said that permanent nerve damage may occur if symptoms are severe and have persisted for a long period of time.
Is Carpal Tunnel Syndrome Treatable?
The condition is curable with carpal tunnel syndrome treatment. Polmateer said to talk to your primary care physician or make an appointment with a physical therapist when symptoms start. Your doctor can determine whether you have carpal tunnel syndrome by testing the feeling and strength of the muscles in your fingers and hand. A wrist flexion test, which measures how fast symptoms appear, may be performed. An X-ray or special tests to measure the electrical impulses of the nerves in your hand may be needed.
Early diagnosis is important. “Patients with early diagnosis may have successful treatment without surgical intervention, but if left untreated, the symptoms may worsen and require surgery to alleviate symptoms,” said Dr. Graner.
Richard Makowiec, MD, an orthopedic surgeon specializing in hand surgery with Franciscan Physician Network with offices in Indianapolis and Mooresville, suggested that anyone experiencing pain and numbness now should seek care immediately.
“The earlier you seek treatment and we intervene, the sooner we can get you back to doing what you love to do,” said Dr. Makowiec.
Nonsurgical treatments for carpal tunnel syndrome may include:
- Bracing or splinting: Wearing a brace or splint at night will keep you from bending your wrist while you sleep. Keeping your wrist in a straight or neutral position reduces pressure on the erve in the carpal tunnel. It may also help to wear a splint during the day when doing activities that aggravate your symptoms.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen and naproxen can help relieve pain and inflammation.
- Activity changes: If your job or recreational activities aggravate your symptoms, changing or modifying these activities can help slow or stop progression of carpal tunnel syndrome. In some cases, this may involve making changes to your work site or work station.
- Nerve gliding exercises: Some patients may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel. Specific exercises may be recommended by your doctor or therapist.
- Steroid injections: Corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the carpal tunnel. Although these injections often relieve painful symptoms or help to calm a flare up of symptoms, their effect is sometimes only temporary.
Surgery for carpal tunnel syndrome
If a patient’s symptoms resurface or do not go away with nonsurgical treatments, the next step may be surgery. Sometimes, surgery is needed to open the size of the carpal tunnel itself and decrease pressure on the nerve and tendons.
“The surgery is very common, quick, and safe. Most people go home the same day, and have it done under local anesthesia,” Dr. Makowiec said.
The procedure is called a "carpal tunnel release." There are two different surgical techniques for doing this, but the goal of both is to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. This increases the size of the tunnel and decreases pressure on the median nerve.
For most patients, their symptoms disappear after surgery. Recovery time may vary, however, depending on how long a patient waits before seeking treatment, or how damaged the median nerve is.
Can I Prevent Carpal Tunnel Symptoms?
There are actions that you can take to help prevent the symptoms of carpal tunnel syndrome:
- Minimize repetitive hand movements; if not possible, take frequent breaks. Alternate tasks in a project.
- Change the grip on your tools or use a tool that allows you to grip it with your whole hand, not just your thumb and index finger.
- If you work with tools that vibrate, use padded gloves designed to absorb vibration.
- Reduce the speed and force of repetitive movements. For instance, lighten your touch on your computer keyboard.
- When texting on your mobile phone, use your index finger instead of your thumbs, and use the word suggestion feature to minimize typing.
Read more tips for handling hand pain at work.
By Ariel Anderson
Social Media Specialist