What is carpal tunnel syndrome?

woman rubbing painful hand 
Have you experienced pain, numbness and tingling in your hand and arm? If so, you may be suffering from carpal tunnel syndrome.
 
This is a common condition that occurs when the median nerve – one of the major nerves to the hand — is squeezed or compressed as it travels through the wrist at the base of your palm.
 
The most common symptoms patients experience include numbness and tingling in the fingers that can occur during the day or night. When it occurs at night time, it usually wakes people from their sleep. During the day, you may notice your symptoms worsen when you hold a phone to your ear or when you drive.
 
It may also be associated with clumsiness or perceived weakness in grip. As it progresses, the symptoms can progress from being intermittent to constant, from mild to dense numbness, and from no weakness to profound weakness of the thumb.
 
If your symptoms are new and are only intermittent and mild in nature, then it may be okay to observe it. However, if the symptoms have been present for a while or if the symptoms are becoming more frequent and more severe, then it may be time to see a hand specialist.
 
What causes carpal tunnel syndrome?
 
Most cases of carpal tunnel syndrome are what we call idiopathic— we don’t necessarily have a clear reason why it occurred.
 
However, it has been associated with increasing age, gender (women tend to get it more often than men), and some systemic diseases including rheumatoid arthritis, diabetes, hypothyroidism, gout, amyloidosis, pregnancy, menopause and obesity.
 
Certain activities or occupations may exacerbate symptoms related to carpal tunnel syndrome, particularly those that may cause prolonged positioning of the wrist in flexion or extension. It can also be associated with masses or tumors. Sometimes a traumatic injury, such as a broken wrist, can incite carpal tunnel syndrome as well.
 
What are the treatment options?
 
The treatment options for carpal tunnel syndrome include:
 
  • observation
  • neutral wrist brace
  • steroid injection
  • surgery (carpal tunnel release)
In general, mild and intermittent symptoms can be treated with observation or a neutral wrist brace worn primarily at night. If symptoms become more frequent but are still intermittent, a wrist brace or sometimes a steroid injection can be used for treatment.
 
If the symptoms persist despite non-operative treatment, or if there are severe or constant symptoms of carpal tunnel syndrome, then surgery is often advisable to prevent permanent damage.
 
When should you see doctor?
 
You should see your doctor if you’re experiencing numbness and tingling in your hand or fingers and you don't know what’s causing it. Sometimes these symptoms are associated with carpal tunnel syndrome, other times it can be associated with cervical radiculopathy or a pinched nerve in the neck or other types of nerve dysfunction.
 
You should also see your doctor if you've noticed weakness in your hand that you otherwise can’t explain. Sometimes, the first sign of a problem is atrophy or wasting away of muscles in the hand.
 
Finally, you should see your doctor if you have pain in the hand, wrist, elbow or shoulder. Classic carpal tunnel syndrome will cause symptoms of numbness and tingling in the fingers that often wakes people from their sleep. Sometimes carpal tunnel syndrome will present with symptoms of hand cramping, weakness, or even pain in the elbow or shoulder.
 
When is surgery necessary?
 
Your doctor may do electrodiagnostic testing to measure the speed and degree of electrical activity in your muscles and nerves to determine the severity of the condition.
 
Surgery may be necessary. Why? Because permanent damage to the median nerve may have already occurred – and to stop continued permanent damage – the pressure on the nerve should be removed with surgery. In some cases, the nerve damage can recover with surgery, but in other cases, it can’t.
 
At Ohio State Wexner Medical Center, our expert hand surgeons at the Hand Center can perform the operation while you receive sedation ("twilight" anesthesia) or while you’re awake. We direct local anesthetic into the surgical site so that you won’t feel pain during the operation, even if you’re awake.
 
Can carpal tunnel syndrome return after treatment?
 
Carpal tunnel release is generally a successful surgery, and in the vast majority of patients it improves bothersome symptoms of numbness and tingling, especially at night. This surgery can also improve arm pain and hand strength.
 
The vast majority of patients who’ve had a carpal tunnel release will never need a second operation to re-release it. However in a very small subset of patients, carpal tunnel syndrome can return – typically several years after the initial surgery.
 
Before the diagnosis of recurrent carpal tunnel syndrome is made, a thorough history, exam and electrodiagnostic study should be performed to ensure there are no other causes for the symptoms. 
If after thorough investigation it’s determined that carpal tunnel syndrome did return despite surgery, then it’s reasonable to perform another surgery.
 
Kanu Goyal is an orthopedic hand and upper extremity surgeon at Ohio State Wexner Medical Center.
 
 
 

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