Carpal Tunnel Syndrome
The carpal tunnel is a narrow, tunnel-like structure in the wrist. The bottom and sides of this tunnel are formed by wrist (carpal) bones. The top of the tunnel is covered by a strong band of connective tissue called the transverse carpal ligament. The median nerve travels from the forearm into the hand through this tunnel in the wrist. The median nerve controls feeling in the palm side of the thumb, index finger, and long fingers. The nerve also controls the muscles around the base of the thumb. The tendons that bend the fingers and thumb also travel through the carpal tunnel. These tendons are called flexor tendons.
Carpal tunnel syndrome occurs when the tissues surrounding the flexor tendons in the wrist swell and put pressure on the median nerve. These tissues are called the synovium. The synovium lubricates the tendons and makes it easier to move the fingers.
This swelling of the synovium narrows the confined space of the carpal tunnel, and over time, crowds the nerve.
Carpal tunnel syndrome is caused by pressure on the median nerve traveling through the carpal tunnel.
Many things contribute to the development of carpal tunnel syndrome:
Heredity is the most important factor - carpal tunnels are smaller in some people, and this trait can run in families.
Hand use over time can play a role.
Hormonal changes related to pregnancy can play a role.
Age — the disease occurs more frequently in older people.
Medical conditions, including diabetes, rheumatoid arthritis, and thyroid gland imbalance can play a role.
The most common symptoms of carpal tunnel syndrome include:
Numbness, tingling, and pain in the hand
An electric shock-like feeling mostly in the thumb, index, and long fingers
Strange sensations and pain traveling up the arm toward the shoulder
Symptoms usually begin gradually, without a specific injury. In most people, symptoms are more severe on the thumb side of the hand. Symptoms may occur at any time. Because many people sleep with their wrists curled, symptoms at night are common and may awaken you from sleep. During the day, symptoms frequently occur when holding something, like a phone, or when reading or driving. Moving or shaking the hands often helps decrease symptoms. Symptoms initially come and go, but over time they may become constant. A feeling of clumsiness or weakness can make delicate motions, like buttoning your shirt, difficult. These feelings may cause you to drop things. If the condition is very severe, muscles at the base of the thumb may become visibly wasted.
If diagnosed and treated early, carpal tunnel syndrome can be relieved without surgery. In cases where the diagnosis is uncertain or the condition is mild to moderate, your doctor will always try simple treatment measures first:
Bracing or splinting. A brace or splint worn at night keeps the wrist in a neutral position. This prevents the nightly irritation to the median nerve that occurs when wrists are curled during sleep. Splints can also be worn during activities that aggravate symptoms.
Activity changes. Changing patterns of hand use to avoid positions and activities that aggravate the symptoms may be helpful. If work requirements cause symptoms, changing or modifying jobs may slow or stop progression of the disease.
Physical Therapy-pain relieving, stretching, and decreasing pressure from the carpal tunnel are only few of the options your PT has to help you cope with the condition
Surgery may be considered if you do not gain relief from nonsurgical treatments. The decision whether to have surgery is based mostly on the severity of your symptoms. There are different techniques to achieve decompression at the carpal tunnel mostly by cutting the ligament at the top of the tunnel. Our orthopedic surgeons will be happy to help you understand the surgical options and their outcomes.