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Carpal Tunnel Syndrome

Do you experience tingling, pain, weakness and numbness in your fingers, hand or forearm? These feelings may be symptoms of carpal tunnel syndrome (CTS). This condition happens when excessive pressure on the median nerve runs from the forearm into the palm of the hand. CTS may worsen if left untreated, resulting in permanent nerve damage and hand disability.

If you feel any carpal tunnel symptoms, visit a doctor to get checked as soon as possible. Our carpal tunnel doctors at Nacogdoches Medical Partners in Nacogdoches, TX can help diagnose, evaluate and treat CTS.

What Is The Carpal Tunnel?

The carpal tunnel is a narrow passage located in the wrist. It is made of bones on three sides and a ligament across the wrist where the forearm and palm meet. The carpal tunnel is where the median nerve and tendons that bend the fingers pass through. The median nerve provides sensation to the middle, thumb and index fingers and a part of the ring finger.

What Causes Carpal Tunnel Syndrome?

Carpal tunnel pain may be caused by swelling or inflammation of the tendons or the nerve inside the tunnel, resulting in added pressure on the median nerve. Sometimes, no single cause for CTS can be identified. Contributing factors to this condition may include:

  • Wrist injury
  • Imbalance of either the thyroid or pituitary gland
  • Arthritic conditions
  • Frequent use of vibrating hand tools
  • Repetitive motions using the hands
  • Fluid retention during menopause or pregnancy
  • Cyst or tumor in the carpal tunnel
  • Metabolic disorders affecting the nerves and increasing their risk of compression

What Are The Symptoms of Carpal Tunnel Syndrome?

Symptoms may start gradually and often appear in one or both hands, with the dominant hand usually affected first. Carpal tunnel syndrome symptoms include:

  • Numbness in the fingers, particularly at night
  • The fingers feel swollen or useless
  • A tingling sensation in the fingers
  • Some loss of movement in the hand
  • Hand weakness that makes it difficult to perform some tasks by hand

Some people with severe carpal tunnel syndrome cannot feel whether something is hot or cold through their fingers. If left untreated, this condition may shrink the muscles at the thumb’s base. Schedule an appointment with a doctor for a proper diagnosis if you experience signs of carpal tunnel syndrome.

How To Diagnose Carpal Tunnel?

A Carpal Tunnel Syndrome diagnosis may include the following:

  • Physical examination – your doctor will examine your hands, shoulders, arms and neck to rule out other conditions. Your wrists will be checked for swelling, warmth, tenderness and discoloration. The doctor will test your fingers’ sense of touch and check for signs of muscle degeneration on your hand.
  • X-rays and routine laboratory tests – to see if you have arthritis, fractures or other nerve-damaging conditions.
  • Wrists tests – to identify CTS symptoms.
    • Tinel test – the doctor presses or taps on your wrist. The test is positive if your fingers tingle or have a shock-like sensation.
    • Phalen (wrist-flexion) test – involves pressing the backs of your hands together with your forearms held upright and your fingers pointing down. If you have carpal tunnel syndrome, you will feel increasing numbness in your fingers within a minute. Your doctor may also ask you to perform other movements to bring on symptoms.
  • Electrodiagnostic tests
    • Nerve conduction study – Using electrodes, your doctor will measure how quickly impulses are transmitted along your nerve.
    • Electromyography – this test aims to help find muscle and nerve problems. It involves using a small needle through the skin into a muscle. The needle picks up electrical activity and records it on a monitor through wave lines.
  • Imaging tests may be performed if the doctor suspects other conditions may contribute to pain.
    • Ultrasound – to show an abnormality of the median nerve.
    • Magnetic resonance imaging (MRI) – to check your wrist’s anatomy.

During the process for a carpal tunnel syndrome diagnosis, your doctor may diagnose you with other conditions that can cause tingling or numbness in the hand, such as myofascial pain syndrome, peripheral neuropathy or compression conditions that affect the neck, shoulder, elbow or forearm. Your doctor will recommend treatment based on your diagnosis.

How To Treat Carpal Tunnel Syndrome

Your doctor will recommend nonsurgical treatments first, as carpal tunnel syndrome can often be relieved without surgery if diagnosed and treated early. Carpal tunnel syndrome treatments may include:

  • Splinting or bracing – wearing a splint or brace when sleeping will keep your wrist in a neutral position, reducing the pressure on your median nerve. You may also wear a splint when performing activities that usually worsen your symptoms.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – your doctor may prescribe pain relievers to relieve your symptoms.
  • Nerve gliding exercises – your doctor or therapist may recommend exercises to help your median nerve move more freely in your carpal tunnel.
  • Steroid injections – powerful anti-inflammatory medications may be injected into the carpal tunnel to help relieve painful symptoms.
  • Activity changes – you may need to adjust the positioning of your hand and wrist when doing certain activities aggravate your symptoms.

Your doctor may recommend carpal tunnel surgery if nonsurgical treatments do not relieve your symptoms. Carpal tunnel release is the surgical treatment for carpal tunnel syndrome. In this procedure, the transverse carpal ligament, which forms on the tunnel’s roof, will be cut to relieve pressure on the median nerve.

What Is Carpal Tunnel Surgery?

The surgical treatment for carpal tunnel syndrome involves cutting the transverse carpal ligament (the flexor retinaculum) to reduce pressure on the median nerve. There are two possible procedures for this surgery:

  • Open carpal tunnel release – the carpal tunnel surgeon cuts the inside of the wrist and right through the ligament.
  • Endoscopic carpal tunnel release – the surgeon uses an endoscope (a very small camera) inserted into a cut in the hand to monitor the surgical procedure and guide surgical instruments that will cut the ligament.

The chances of successful carpal tunnel release surgery are higher if your condition is in an early stage. For most people, symptoms usually go away after surgery. Depending on the extent of nerve damage, it may take several weeks or months for more severe symptoms to disappear.

After the surgery, your hand is bandaged. You will be encouraged to move your fingers and elevate your hand to prevent stiffness and reduce swelling. Swelling, pain and stiffness and soreness are normal right after the procedure. The stitches may be removed in about two weeks.

Your doctor may recommend wearing a splint to keep your wrist as still as possible. Avoid heavy activity that will strain your hand for a few weeks so that your wound may heal properly. Talk to your doctor about when you can resume driving and other activities.

Your pinch and grip strength may return about three months after your surgery but may take up to 12 months if your median nerve’s condition had been poor before surgery. Some patients with severe carpal tunnel conditions may not completely recover their normal hand strength, but surgery is still necessary to prevent their condition from worsening and losing nerve function.

How To Prevent Carpal Tunnel Syndrome?

There is no single way to prevent CTS, but you can adjust your work area or how you perform tasks to place less stress on your wrists and hands. Proper posture and exercises to strengthen your hands, fingers, shoulders, forearms and neck may also help. You may also benefit from professional advice from a physical or occupational therapist.

For patients diagnosed with CTS, these activities may help reduce CTS symptoms:

  • Avoid repetitive hand movements or holding vibrating tools for too long, heavy grasping
  • Quit smoking
  • Maintain a healthy weight
  • Reduce caffeine consumption
  • Wearing a wrist brace

Do Not Ignore Symptoms of Carpal Tunnel Syndrome

Schedule an appointment with a doctor if you think you are experiencing CTS. Early treatment may help relieve your symptoms and prevent your condition from worsening.