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Carpal Tunnel Syndrome
Description
Carpal tunnel syndrome is a common source of hand numbness and
pain. It is more common in women than men and affects up to 10 percent
of the population. It is caused by increased pressure on a nerve
entering the hand through the confined space of the carpal tunnel.
The median nerve travels from the forearm into your hand through
a tunnel in your wrist. The bottom and sides of this tunnel are formed
by wrist bones and the top of the tunnel is covered by a strong band
of connective tissue called a ligament. Your doctor may make the diagnosis
by discussing your symptoms and examining you. If symptoms continue
to bother you, electrical testing of the nerve function is often performed
to help confirm the diagnosis and clarify the best treatment option
in your case.
Symptoms
Symptoms usually begin gradually without a specific injury. Numbness,
tingling and pain in the hand are common. You may experience an electric-like
shocking feeling. The thumb side of the hand is usually most involved.
Symptoms at night are common and may awaken you from sleep. During
the day symptoms frequently occur with holding a phone, reading or
driving. Symptoms may occur at any time. Moving or shaking the hands
often helps decrease symptoms. Sometimes strange feelings and pain
will travel up the arm. Initially symptoms come and go, but over time
they may become constant. A feeling of clumsiness or weakness can make
delicate motions like buttoning buttons difficult and may cause you
to drop things. If the condition is very severe, muscles in the palm
may become visibly wasted.
Risk Factors
The actual cause is unknown in most people. Carpal tunnel syndrome
is more common in women. In women, the swelling that occurs during
pregnancy may cause symptoms, but those will frequently go away after
delivery. Carpal tunnel syndrome becomes more common as we grow older
and seems to affect people with certain medical conditions such as
diabetes, thyroid conditions and rheumatoid arthritis more frequently.
Treatment Options
Symptoms can often be relieved without surgery. Treatment often
begins with a brace or splint worn at night to keep the wrist
in a natural position. Splints can also be worn during activities that
aggravate symptoms. Simple medications such as Tylenol® or Advil® can
help decrease pain. Changing patterns of hand use to avoid
aggravating positions and activities may be helpful. A corticosteroid
injection
will often provide temporary relief, but symptoms may come
back.
If your carpal tunnel syndrome continues to bother you and you do
not gain relief from non-surgical treatments, surgery can be effective
in diminishing symptoms. Because carpal tunnel syndrome is not a dangerous
problem, the decision whether to have surgery is based mostly on the
severity of your symptoms.
- If your symptoms are severe and won't go away you may want to
consider surgery.
- In more severe cases, surgery is considered sooner because other
treatment options are less helpful.
- In very severe cases, surgery may be recommended to prevent irreversible
damage.
Treatment Options: Surgical
The strong roof of the carpal tunnel is cut during carpal tunnel
surgery to increase the size of the tunnel and decrease pressure
on the nerve. This is done through an incision in the palm or wrist.
A small camera may be used to allow the surgery to be performed through
a smaller incision. Risks of the surgery include bleeding, infection
and nerve injury. Some pain, swelling and stiffness are expected,
but severe problems are rare.
After surgery, elevating the hand and moving the fingers helps
minimize swelling and stiffness. Minor soreness in the palm is common
for several months after surgery. Most patients have improvement following
surgery, but recovery may be gradual. When carpal tunnel syndrome has
been present longer and the nerve is more severely affected, recovery
is slower and less complete.
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