Treating Symptoms of Carpal Tunnel Syndrome

Do you suffer from pain or numbness in your wrist and hand? These could be symptoms of carpal tunnel syndrome, a nerve compression disorder that strikes women three times as often as men. Early treatment is essential to avoid permanent damage. Find out what causes this ailment, how to get carpal tunnel relief, and preventive measures you can take…

You’re working at your desk, trying to ignore the tingling or numbness you’ve had for months in your hand and wrist. Suddenly, a sharp, piercing pain shoots through the wrist and up your arm.

Just a passing cramp? More likely you have symptoms of carpal tunnel syndrome, a painful progressive condition caused by compression of a key nerve in the wrist.

What is carpal tunnel syndrome?
It occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. This nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move.

The carpal tunnel – a narrow, rigid passageway of ligament and bones at the base of the hand – houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed.

The result may be pain, weakness or numbness in the hand and wrist, radiating up the arm. The dominant hand is usually affected first and produces the most severe pain.

Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies – a term for when the body’s peripheral nerves are compressed or traumatized.

What are the symptoms of carpal tunnel syndrome?
They usually start gradually, with frequent burning, tingling or itching numbness in the palm of the hand and fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent.

The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with the syndrome may wake up feeling the need to “shake out” the hand or wrist.

As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects or perform other manual tasks. In chronic or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.

What causes the symptoms of carpal tunnel syndrome?
It’s often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself.

Most likely the disorder is due to a congenital predisposition – the carpal tunnel is simply smaller in some people than others.

Other contributing factors include:

Trauma or injury to the wrist that causes swelling, such as sprain or fracture

Overactivity of the pituitary gland (which can lead to excess growth hormone)

Hypothyroidism (which causes a deficiency in thyroid hormone)

Mechanical problems in the wrist joint

Work stress

Repeated use of vibrating hand tools

Fluid retention during pregnancy or menopause

The development of a cyst or tumor in the canal

But in some cases, no cause can be identified. There’s little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis.

Writer’s cramp – a condition in which repetitive activity causes a lack of fine motor skill coordination and ache and pressure in the fingers, wrist or forearm – is not a symptom of carpal tunnel syndrome.

How is carpal tunnel syndrome diagnosed?
A physical examination of the hands, arms, shoulders and neck can help determine if the patient’s complaints are related to daily activities or an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome.

The wrist is examined for tenderness, swelling, warmth and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy.

Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome.

In the Tinel test, the doctor taps on or presses on the median nerve in the patient’s wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs.

The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute.

Doctors may also ask patients to try to make a movement that brings on symptoms.

It’s often necessary to confirm the diagnosis by use of electrodiagnostic tests:

In a nerve-conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured.

In electromyography, a fine needle is inserted into a muscle; electrical activity viewed on a screen can determine the severity of damage to the median nerve.

Ultrasound imaging can show impaired movement of the median nerve.

Magnetic resonance imaging (MRI) can show the anatomy of the wrist but has not been found especially useful in diagnosing carpal tunnel syndrome.
How is the syndrome treated?
Carpal tunnel treatment should begin as early as possible, under a doctor’s direction, to avoid permanent damage to the median nerve.

Underlying causes such as diabetes or arthritis should be treated first.

Initial treatment generally involves resting the affected hand and wrist for at least two weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there’s inflammation, applying cool packs can help reduce swelling.

Non-surgical treatments
Drugs: In special circumstances, various medications can ease the pain and swelling associated with carpal tunnel syndrome.

Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity.

Orally administered diuretics (“water pills”) can decrease swelling.

Corticosteroids (such as prednisone) or the local anesthetic lidocaine can be injected directly into the wrist, or prednisone can be taken orally, to relieve the median nerve compression and provide immediate, temporary relief to people with mild or intermittent symptoms. (Corticosterioids shouldn’t be taken without a doctor’s prescription; they can make it difficult for those with diabetes to regulate insulin levels.)

Also, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.

Exercise: Stretching and strengthening exercises can help people whose symptoms have abated. These exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.

Alternative therapies: Acupuncture and chiropractic care have benefited some patients, but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.

Surgery
Carpal tunnel release is one of the most common surgical procedures in the United States. It’s generally recommended if symptoms last for six months.

The surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. This is done under local anesthesia and doesn’t require an overnight hospital stay. Many patients require surgery on both hands.

The following are types of carpal tunnel release surgery:

Open release surgery, the traditional procedure used to correct the symptoms of carpal tunnel syndrome, involves making an incision up to 2 inches in the wrist and then cutting the carpal ligament (the tissue that holds joints together) to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.

Endoscopic surgery may allow faster functional recovery and less postoperative discomfort. The surgeon makes two incisions (about 1/2 inch each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament. This two-portal endoscopic surgery, generally performed under local anesthesia, minimizes scarring and scar tenderness, if any.

Single-portal endoscopic surgery is also available, and can result in less post-operative pain and a minimal scar. It generally allows individuals to resume some normal activities in a short time.

Although symptoms may be relieved immediately after surgery, full recovery can take months. Some patients may have infection, nerve damage, stiffness and pain at the scar.

Occasionally, the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.

Recurrence following carpal tunnel treatment is rare. The majority of patients recover completely.

How can carpal tunnel syndrome be prevented in the workplace?
Workers can do on-the-job conditioning and stretching exercises, and take frequent rest breaks.

They can wear splints to keep wrists straight, and use correct posture and wrist position.

Wearing fingerless gloves can help keep hands warm and flexible.

Workstations, tools and tool handles, and tasks can be redesigned to enable the worker’s wrist to maintain a natural position during work.

Jobs can be rotated among workers.

Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of the symptoms of carpal tunnel syndrome.

For more on chronic pain, visit our Pain Management Health Center.

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