CARPAL TUNNEL SYNDROME

What’s Carpal Tunnel Syndrome?

In your wrist, a strip of tissue called the Transverse Carpal Ligament stretches across the wrist like a watchband. If sufficiently overworked, this ligament can thicken and tighten, clamping down on the median nerve that brings signals from the brain to the hand. Impinging the median nerve causes Carpal Tunnel Syndrome, which leads to numbness, tingling, soreness, and weakness in the affected wrist.

How do Upper Extremity Specialists Treat Carpal Tunnel Syndrome?

• Lifestyle modifications: decreasing repetitive hand and wrist movements and modifying activities to decrease extremes of wrist flexion and extension for long periods of time.
• Wrist cock-up brace: will hold the wrist in 20 degrees extension to create the most area within the carpal tunnel.
• NSAID medications: found to be equivalent to placebo for carpal tunnel treatment in scientific trials, but some patients may benefit from their use.
• Physical therapy: stretches and nerve gliding exercises can help mild carpal tunnel syndrome. The AAOS offers a recommended program that you can try at home: https://orthoinfo.aaos.org/globalassets/pdfs/a00789_therapeutic-exercise-program-for-carpal-tunnel_final.pdf
• Cortisone injections: can confirm the diagnosis in equivocal cases and correlate with successful symptom resolution after a surgical release.
• Endoscopic carpal tunnel release: a minimally invasive release of the carpal tunnel ligament performed with an endoscopy camera the size of a small pen, inserted through a small incision at the wrist crease.
• Open carpal tunnel release: a classic surgical release with an incision made in the palm over the carpal tunnel ligament.

Symptoms of Carpal Tunnel Syndrome:

1. Numbness and Tingling: The most common symptom is numbness and tingling, usually affecting the thumb, index, middle, and part of the ring finger. This sensation is often described as pins and needles.
2. Pain: Pain can radiate from the wrist up the arm or down into the hand and fingers. The pain may be more intense during activities that involve bending the wrist, such as holding a phone or a book.
3. Weakness: Weakness in the hand, particularly in grip strength, may develop due to the compression of the median nerve.
4. Burning Sensation: Some individuals experience a burning sensation in the affected hand.
5. Shock-like Sensations: In some cases, individuals with CTS may feel sudden, shock-like sensations radiating from the wrist to the hand and fingers.
6. Hand Discomfort: The affected hand might feel swollen or puffy, even if there is no visible swelling.
7. Worsening at Night: Symptoms often worsen at night, leading to sleep disturbances and waking up with tingling or pain.

Causes of Carpal Tunnel Syndrome:

1. Repetitive Movements: Engaging in repetitive activities that involve flexing and extending the wrist over time can strain the wrist and contribute to CTS. Typing, using a computer mouse, and assembly line work are examples.
2. Wrist Positioning: Prolonged or sustained wrist flexion (bending the wrist downward) or extension (bending the wrist upward) can increase pressure within the carpal tunnel and compress the median nerve.
3. Anatomy: Some individuals have a naturally narrower carpal tunnel, which increases the risk of median nerve compression.
4. Wrist Injuries: Fractures, sprains, or dislocations of the wrist can cause swelling and inflammation that can compress the median nerve.
5. Medical Conditions: Diabetes, rheumatoid arthritis, hypothyroidism, and obesity are conditions associated with an increased risk of CTS.
6. Hormonal Changes: Hormonal changes during pregnancy or menopause can affect wrist tissues and fluid retention, potentially leading to nerve compression.

Treatment of Carpal Tunnel Syndrome:

1. Rest and Activity Modification: Giving the affected wrist time to rest and avoiding activities that exacerbate symptoms can help.
2. Wrist Splints: Wearing a wrist splint, especially at night, can help keep the wrist in a neutral position and alleviate pressure on the median nerve.
3. Medications: Over-the-counter pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce inflammation and pain.
4. Physical Therapy: Exercises to improve wrist strength and flexibility can be beneficial.
5. Corticosteroid Injections: In some cases, corticosteroid injections may be used to reduce inflammation and relieve symptoms.
6. Surgery: Carpal tunnel release surgery might be considered for severe or persistent cases that don’t respond to other treatments.

If you suspect you have carpal tunnel syndrome or are experiencing symptoms consistent with CTS, consult a healthcare professional for proper evaluation and treatment. Early intervention can prevent further nerve damage and improve outcomes.

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