Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is one of the most common issues seen by hand surgeons.  The median nerve runs through your forearm, wrist, and hand and supplies sensation to the thumb, index finger, long finger, and half of the ring finger, as well as multiple muscles that control the thumb.  At the level of the wrist, it runs through the “carpal canal” or “carpal tunnel” with all nine tendons that all you to flex your fingers.  If there is swelling in this area or otherwise pressure on the nerve, you might feel numbness, tingling, or even pain in your fingers, hand, and sometimes forearm.

Most CTS is “idiopathic,” meaning that the cause is unknown.  It can be associated with traumatic injuries like fractures (which cause narrowing of or swelling in the canal), fluid retention (as in pregnancy), hypothyroidism, rheumatoid arthritis, and diabetes. 

The most common symptoms include pain, numbness, and tingling in the thumb, index, long, and ring fingers, which are supplied by the median nerve.  Night symptoms are common because we often sleep with our wrists curled or flexed, which compresses the nerve more.  You might feel symptoms while driving, reading a newspaper, or holding a telephone, or during gripping activities.  Some people actually start dropping objects or feeling clumsy with their hands.  In severe cases, you could lose sensation or control of the thumb permanently.

Diagnosis is made by history and examination by your doctor.  X-rays can determine if there are any bony reasons for the symptoms.  A nerve conduction study (NCV) and/or electromyogram (EMG) might be performed to confirm the diagnosis and to check for other nerve problems.

Conservative treatment includes eliminating contributory factors, whether from medical problems or behavior; activity modification can be helpful.  Contrary to public belief, the latest research demonstrated that people who type more have a lower incidence of carpal tunnel syndrome!  Your positioning at your desk, however, can make a big difference.  You want to make sure that your wrists are in “neutral” and that you are not leaning your palm (or forearm) on anything while you type.

Wearing wrist splints at night can help relieve night symptoms. Corticosteroid injections that decrease inflammation around the nerve can help your doctor with the diagnosis or, in limited situations, can treat the symptoms.

Surgical release of the carpal tunnel by cutting the ligament overlying the nerve and tendons in the palm of the hand enlarges the tunnel and decreases the pressure on the nerve.  Soreness in the palm can last for weeks to months.  Numbness and tingling can disappear quickly or slowly.  Strength in the hand and wrist can take a few months to return to normal.  It is important to note that symptoms might not completely go away after surgery, especially in severe cases.