Carpal Tunnel Syndrome

Carpal Tunnel Syndrome: When Your Hand and Wrist Hurt & You Don’t Know What to Do

Carpal tunnel syndrome is a condition involving the hand and the arm. This condition is characterized by tingling and numbness in the hand/arm and is a result of a pinched nerve in the wrist.

There are several different factors that can contribute to this condition, including:

  • Anatomy of your wrist
  • Underlying health conditions
  • Patterns of hand usage

The carpal tunnel is a passageway that is located on the palm side of your wrist and is bound by ligaments and bones. It is meant to protect one of the main nerves to your hand as well as the nine tendons that facilitate the bending of your fingers.

When this nerve becomes compressed, you get a numb, tingling feeling which will eventually lead to weakness of the hand that comes with this condition. However, in most cases, individuals who do develop this condition can get relief from the numbness and tingling as well as restore functioning of their hand and wrist with the proper treatment.

Signs and Symptoms of Carpal Tunnel Syndrome

Typically, this condition starts out gradually. You will begin to feel some numbness and/or tingling in your thumb, middle, and index fingers that will come and go. The numbness/tingling could also be accompanied by some discomfort in both your wrist and your hand. Some of the most common symptoms of carpal tunnel syndrome include:

Tingling and/or numbness

You might have some tingling and/or numbness in your fingers and/or hand- with the exception of your little finger. You notice this most often when you’re holding something in the affected hand, or when you first wake up from sleeping. You may also notice that you feel the sensation from your wrist all the way up your arm.

Many times, an individual will try to “shake out” the feeling by shaking their hands to relieve the symptoms of carpal tunnel. Unfortunately, as the disorder continues, the numbness will become much more common.

Weakness

You may notice that you have a hard time holding things in your hand and tend to drop things more often. This could be a result of the numbness in your hand or possibly the weakness associated with the thumb muscles. The thumb muscles are associated with the median nerve.

When You Should See Your Physician

If you are having persistent symptoms that are indicative of carpal tunnel syndrome- especially if they are interfering with your sleep patterns and normal daily functioning, you should see your physician as soon as possible. Leaving this condition untreated could result in muscle and nerve damage.

what is carpal tunnel syndrome and what causes it

Causes of Carpal Tunnel Syndrome

This condition is a result of the median nerve becoming compressed. The median nerve is the nerve running from your forearm through the passageway, or carpal tunnel, in your wrist to your hand.

This nerve is what provides the nerve sensations on the palm side of your hand to your thumb and fingers, except your pinky. In addition, this nerve also sends the nerve signals to move the muscles around the base of your thumb.

Basically, anything crowding, irritating, or compressing this nerve can result in carpal tunnel syndrome. If you fracture your wrist, you risk narrowing the carpal tunnel, which will irritate the nerve- and cause carpal tunnel. In addition, if you have rheumatoid arthritis, the inflammation and swelling can cause you to develop carpal tunnel.

In most cases, there is no single cause that can be pinpointed. Scientists believe that the development of this condition is due to a combination of risk factors.

Risk Factors for Carpal Tunnel Syndrome

There are actually many risk factors that have been found to be associated with the condition of carpal tunnel. Though alone, they do not actually cause this condition, they do possibly increase your risk of developing or even aggravating median nerve damage. Some of these risk factors include the following:

Anatomic Factors

A wrist dislocation or facture can alter the space in the carpal tunnel and therefore cause extraneous pressure on the median nerve. Individuals who have smaller carpal tunnels are possibly at a greater risk for developing this condition.

Sex

This condition is much more common in women than in men. This is due to the fact that most women are smaller than men and therefore have smaller carpal tunnels. Women who do develop this condition generally have smaller carpal tunnels than women who do not develop this condition.

Nerve Damaging Conditions

in some cases, a chronic illness such as diabetes, can increase your risk of developing nerve damage- especially to your median nerve, which can result in the condition of carpal tunnel.

Inflammatory Conditions

illnesses characterized by inflammation such as RA, can have an effect on the tendons located in your wrist, which puts pressure on the median nerve, increasing your chance of developing this condition.

Alterations in bodily fluids

Often, when a woman is pregnant or going through menopause, she retains fluid. This can result in pressure on the carpal tunnel, which irritates the median nerve. If your condition is a result of your pregnancy, it will most likely resolve after you give birth.

Other medical conditions

conditions such as thyroid disorders, kidney failure, obesity, and menopause can increase your risk of developing this condition.

Work Related Factors

It is quite possible that working in an assembly line requiring prolonged/repetitive wrist flexing or using vibrating tools can put pressure on the median nerve, which can cause or worsen nerve damage.

On the other hand, the evidence is very conflicting and none of the above factors have been proven to cause or worsen the condition of carpal tunnel. There have been several studies that have looked at the association of carpal tunnel syndrome and computer usage.

However, there has not been enough consistent, quality evidence that supports computer use as a risk factor for developing carpal tunnel- but it can cause other forms of hand pain.

Diagnosing Carpal Tunnel Syndrome

There are several different tests that your physician can use to determine whether or not you are suffering from this condition. These are as follows:

Symptom History

Your physician will discuss your symptoms with you and review them. In most cases, the pattern of your symptoms will help to determine what has caused them and whether or not you have this condition.

One example is: if you are experiencing tingling in your pinky finger, since the median nerve does not offer sensation to that finger, chances are you do not have carpal tunnel, but some other condition of the hand/wrist.

Another great clue is the timing of your symptoms. If you are suffering from carpal tunnel syndrome, you will experience symptoms while holding a phone or other object, gripping your steering wheel, or waking during the night.

Physical Examination

When you visit your physician, he/she will take some time to physically examine your hand/wrist. He/she will test the strength of your hand muscles as well as the feeling in your finger. In most cases, putting pressure on the median nerve at the wrist will bring on the symptoms. This is done by bending your wrist and tapping or pressing on the nerve.

X-ray

In most cases, your physician will recommend an x-ray of your wrist to rule out other possible causes of your pain such as a fracture or arthritis.

Electromyogram

this particular test will measure tiny electrical discharges that are produced in your muscles. Your physician will insert a thin-needle electrode into certain muscles.

This will evaluate electrical impulses in your muscles when they are at rest and when they are active. This will determine whether or not there has been any muscle damage and can also rule out any other possible conditions.

Nerve Conduction Study

This is a variation of electromyography where two electrodes will be taped to your skin. Then, a small shock will be passed through your median nerve. This will measure whether these impulses slow down in your carpal tunnel. This can be used to rule out other conditions and to diagnose carpal tunnel.

what is carpal tunnel syndrome and what causes it

Treating Carpal Tunnel Syndrome

As soon as possible after the onset of your symptoms, you should visit your physician and seek treatment. This will help to prevent irreparable damage to your median nerve.

In some cases, individuals who have mild symptoms of this condition will be able to ease discomfort by simply taking frequent rest breaks, avoiding activities that cause the symptoms to be worse, and using ice packs to help reduce swelling when it occurs.

Of course, if these treatments don’t provide some relief within just a few weeks, other options including medications, surgery, or wrist splinting may be necessary. However, wrist splinting and other more conservative options are usually only likely to be helpful if you have only experienced mild to moderate symptoms for a period of less than ten months.

Nonsurgical Therapy for Carpal Tunnel Syndrome

If your condition is diagnosed early on, there are several nonsurgical methods that may be helpful for improving this condition, including the following:

Wrist Splinting

At night, when you’re sleeping, you may be able to relieve the symptoms of numbness and tingling by putting a splint on your wrist that will hold it still. This is a great option for women who are pregnant.

NSAIDs

Pain relievers are a great option for short-term treatment of the pain associated with carpal tunnel syndrome. However, there is no scientific evidence that these medications can improve this condition.

Corticosteroids

In some cases, your physician may inject a corticosteroid such as cortisone into your carpal tunnel to help with pain relief. This will help decrease swelling and inflammation, relieving the pressure on the median nerve. Oral corticosteroids are not as effective as injections for treating this condition.

If your carpal tunnel syndrome is associated with inflammatory arthritis, treating your arthritis could provide relief of the symptoms of carpal tunnel, but this theory has not yet been proven.

Surgery to Relieve Symptoms of Carpal Tunnel Syndrome

If you have tried the nonsurgical options for treating your carpal tunnel and you are still experiencing the symptoms, surgery may be your best option.

The whole point of carpal tunnel surgery is to relieve the pressure on the median nerve. This is done by cutting the ligament that is pressing on your nerve.

There are two different techniques that can be used to perform carpal tunnel surgery. You should discuss the risks and benefits of each one with your surgeon before you agree to the surgery.

Keep in mind that some of the risks include infections, scars, incomplete release of ligament, vascular and nerve injuries. The final result of both techniques of carpal tunnel surgery are comparable.

Endoscopic Surgery

In this technique, the surgeon will take a telescope-like device with an attached camera to look inside your carpal tunnel and will sever the ligament through one or two very small incisions in your hand/wrist. This results in much less pain than the other technique during the first few weeks following surgery.

Open Surgery

In this technique, your surgeon will make a much larger incision in the palm of your hand and cut the ligament in order to free your nerve. In some cases, a smaller incision can be used, which will possibly reduce risk of developing complications.

During the recovery process following either surgical technique, your ligament will gradually begin to grow back together, and allow more room for the nerve than you had before.

Your physician will tell you to keep using your hand after you have surgery, gradually returning to normal use. However, you should never force an extreme wrist position or use forceful hand motions.

You may experience soreness or weakness for a few months following the surgery. If your carpal tunnel symptoms were severe before your surgery, chances are they will not completely resolve afterwards.

what is carpal tunnel syndrome and what causes it

Lifestyle and Home Remedies for Carpal Tunnel Syndrome

Following are a few things you can do at home that may offer some temporary relief from your symptoms of carpal tunnel syndrome:

  • When doing repetitive activities, you should take frequent, short breaks.
  • When doing repetitive activities, you should stretch your palms/fingers and rotate your wrists.
  • When symptoms flare up, take an OTC pain reliever.
  • When symptoms flare up, use a wrist splint at night while sleeping.
  • Try to avoid sleeping on your hands to ease numbness/pain in your hands/wrists.

If you have recurring or persisting pain/numbness/weakness, you should see your physician immediately.

Alternative Medicine to Treat Carpal Tunnel Syndrome

There are a few alternative therapies that you can integrate into your regular health plan in order to combat the signs/symptoms of carpal tunnel syndrome. You may need to experiment to figure out which treatment will offer you the best results.

Additionally, you will want to speak with your physician before trying these or any other complementary/alternative treatment options.

Yoga: there are several yoga postures that are designed for stretching, strengthening and balancing each of the joints in the upper body as well as the upper body as a whole. These could be beneficial for reducing your pain and improving your grip if you have carpal tunnel syndrome.

Hand Therapy: there is some evidence that points to specific occupational and physical hand therapy techniques that could improve the symptoms of this condition.

Ultrasound Therapy: some evidence suggests that ultrasound can be used to raise the temperature of a specific area which promotes healing and reduces pain. This therapy will need to be done over the course of several weeks before improvement is seen.

what is carpal tunnel syndrome and what causes it

Preventing Carpal Tunnel Syndrome

While there are no strategies that have been proven to help with the prevention of carpal tunnel syndrome, there are some things you can do to minimize the stress on your wrists/hands, such as:

Reducing force/relaxing grip: in many cases, people use much more force than they need to for manual tasks. For example, if you use a cash register on a regular basis, make sure you’re hitting the keys softly.

If you are handwriting for long periods of time, you should be using a large pen with an oversized gripper and ink that is free-flowing. This way, you will not need to grip your pen tightly or press hard on the paper.

Take regular breaks: when you’re doing manual tasks, give yourself a break every now and then. Take some time to gently stretch and bend you wrists. If possible, alternate the tasks you are doing. If you are using vibrating equipment, it is even more critical that you take breaks on a regular basis.

Pay attention to your form: make sure that you’re not bending your wrist all the way up or all the way down. The best position is a relaxed, middle position. If you’re using a keyboard, make sure it is at elbow height or slightly lower.

Make improvements to posture: when you’re not sitting with correct posture, your shoulders will roll forward. This will cause your neck/shoulder muscles to shorten, which compresses the nerves in your neck. In turn, the muscles in your hands, wrists, and fingers can be affected.

Make sure hands are warm: if you are working in a cold environment, you’re much more likely to develop stiffness and pain in your hands. If you’re not able to have control of the temperature where you are working, make sure that you have some fingerless gloves to keep your wrists/hands warm.

Carpal tunnel syndrome is a very uncomfortable condition. While it can’t be entirely prevented, there are some things you can do to deal with it. If you believe that you have this condition, you should speak with your physician- even if just to make sure it’s nothing more serious.

Sources

http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/definition/con-20030332

http://orthoinfo.aaos.org/topic.cfm?topic=a00005

http://www.webmd.com/pain-management/carpal-tunnel/

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