By Yuan Y. Liu, MD, Department of Surgery, Cooper University Hospital
Carpal tunnel syndrome is the compression of the median nerve in the wrist as it passes from the arm to the hand. The median nerves supply sensation to the thumb, index finger and long finger. The median nerve also controls the small muscles of the hand. Without the median nerve, our hands would be numb and weak.
What are the symptoms of carpal tunnel syndrome?
The most common symptoms of carpal tunnel syndrome are
- Numbness, tingling, and pain in the hand.
- An electric-shock-like feeling mostly in the thumb, index finger, and long finger.
- Strange sensations and pain traveling up the arm toward the shoulder.
Symptoms usually begin gradually, and in most people 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.
At first, symptoms may come and go, but over time, symptoms can become constant. A feeling of clumsiness or weakness can make delicate motions, like buttoning your shirt, difficult. These feelings also can cause you to drop things. If the condition is very severe, muscles at the base of the thumb can become visibly wasted.
Why do people get carpal tunnel syndrome?
The answer is not very clear. We used to think that it had to do with how hard we used our hands, but new research shows that this is not the case. Most likely the reason is due to genetic predisposition since some people have tighter carpal tunnels than others.
Other factors include trauma to the wrist that causes swelling, an overactive pituitary gland, hypothyroidism, rheumatoid arthritis, fluid retention during pregnancy or menopause, or the development of a cyst or tumor in the canal. Carpal tunnel syndrome also is associated with such diseases as diabetes, thyroid disease, and rheumatoid arthritis.
How do I know if I have carpal tunnel syndrome?
Early diagnosis and treatment is essential to prevent permanent damage to the nerves, which could mean permanent numbness and weakness. A trained physician can diagnose the condition through a physical exam. In addition to a physical exam, an X-ray of the wrist and hand and a nerve conduction study might be necessary. A nerve conduction study, which is painless, involves placing electrodes on the hand and wrist and measuring the speed in which nerves transmit impulses. Early diagnosis and treatment is essential to prevent permanent damage to the nerves, which could mean permanent numbness and weakness.
How can carpal tunnel syndrome be treated?
Under a physician’s guidance, early carpal tunnel syndrome can be treated with splinting and rest. Steroid injections also can help, but they must be carefully observed as they can cause side effects.
For people who have had symptoms longer than six months, or for those who have failed conservative therapy, surgery is recommended. In surgery, the compressed median nerve can be released through the traditional open-surgery method or via minimally invasive endoscopic release surgery. Both procedures have the same long-term outcomes; however, endoscopic release offers faster recovery with less pain. Many patients choose to have both hands treated at the same time in order to save on recovery time.
Remember, early detection and treatment of carpal tunnel syndrome can prevent permanent pain, numbness and weakness later on. If you suspect that you might have carpal tunnel syndrome, see a physician for evaluation right away.
Dr. Liu is a board-certified plastic surgeon specializing in Endoscopic Treatment for Carpal Tunnel Syndrome.