Carpal tunnel syndrome is a prevalent condition characterized by tingling, numbness, and discomfort in the hand and forearm. It arises when the key nerve in the hand (median nerve) becomes compressed or constricted as it passes through the wrist.
Signs and Symptoms
Carpal tunnel syndrome symptoms normally develop gradually, worsen over time, and eventually prompt medical attention. It can result in lasting nerve damage in the hand if left untreated.
Common symptoms include:
The thumb, index finger and middle fingers can become numb and tingly, while the pinky remains unaffected since the median nerve does not supply it with sensation.
Pain and burning in the hand and wrist that sometimes radiates up the arm toward the elbow.
Hand weakness that leads to reduced grip strength.
Decreased sensation, which makes it difficult to grasp small objects, or causes accidental dropping of items.
Symptoms that worsen at night and disrupt sleep.
Causes & Risk Factors
The majority of carpal tunnel syndrome cases stem from various factors. Research shows that females and older adults are more susceptible to this condition.
Factors likely to raise the risk of developing carpal tunnel syndrome are:
Genetics: Genes usually play a key role. Some persons naturally have a smaller carpal tunnel or structural differences that limit space for the median nerve. These characteristics can be hereditary.
Repetitive hand movements: Engaging in repetitive tasks involving the hands and wrists for a long time can stress the tendons and cause inflammation that is compressing the nerve.
Hand and wrist positioning: Extended extreme flexion or extension of the wrist can elevate pressure on the median nerve.
Pregnancy: During pregnancy, hormonal changes may lead to fluid retention and inflammation, which can place additional pressure on the nerve.
Underlying health conditions: Disorders like rheumatoid arthritis, diabetes, and thyroid disease have been linked to a higher risk of carpal tunnel syndrome.
Diagnosis
During carpal tunnel syndrome diagnosis, one of our clinicians at The Joint Pain Clinic will review your medical history and discuss your symptoms. A detailed exam of your hand and wrist will also be conducted. This assessment may include a number of physical tests, such as:
Tinel’s sign test: The clinician will tap or press along the median nerve on the wrist palm side to see if it triggers tingling sensations in your fingers.
Wrist flexion test (Phelan’s test): You will be asked to bend your wrists, and maintain them flexibly to check for numbness or tingling.
Sensitivity test: A specialized tool will be used to gently touch your fingertips and hands with your eyes closed to assess sensation.
Muscle strength assessment: The clinician will evaluate the strength of the muscles at the base of your thumb, which the median nerve regulates.
Muscle atrophy checks: In advanced cases, muscle shrinkage (atrophy) may be checked, which shows prolonged nerve compression.
Ultrasound imaging: High-frequency sound waves may be used to create pictures of the wrist’s bone and tissue. This allows the physician to assess the median nerve for signs of compression.
Management and Treatment
Conservative options:
Before considering surgery, we will first recommend non-surgical treatments to manage carpal tunnel syndrome. Our options may include:
Addressing and managing underlying medical conditions like diabetes or arthritis that may contribute to nerve compression.
Immobilization using a splint or brace for 4 to 6 weeks to keep the wrist and hand in a neutral position as well as reduce nerve irritation.
Resting the hand for at least two or more weeks.
Applying ice packs to reduce swelling.
Avoiding things that trigger symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, or corticosteroid injections may be prescribed to alleviate pain and swelling.
Engaging in stretching and strengthening exercises after symptoms subside.
Surgical options:
We may recommend carpal tunnel release surgery to relieve pressure on the median nerve if symptoms continue for six months or longer despite conservative treatment.
There are two primary surgical approaches:
Traditional (open) surgery: Involves making a single incision (up to 2 inches) in the palm and wrist to access and release the carpal tunnel.
Endoscopic surgery: Uses one or two small (½-inch) cuts, along with an endoscope equipped with a tiny camera.
The endoscopic method allows the surgeon to see the wrist joint on a monitor, providing a clear view of the cartilage, nerves, ligaments and bones.
The advantages of endoscopic surgery over traditional open surgery are:
Smaller cuts
Reduced soft tissue trauma
Less post-operative pain
Faster recovery time
Lower rate of infection
Minimal scarring
Quicker return to daily activities
Done as an outpatient procedure in most cases
Your surgeon will determine the most appropriate surgical method based on your condition and individual needs.
