Carpal Tunnel Syndrome: Causes, Symptoms, Surgery, and Treatment

The carpal tunnel is an area inside of the wrist containing bones, ligaments, and the median nerve. This nerve is responsible for controlling sensation and facilitating movement of the thumb and the three fingers closest to the thumb. If the median nerve is compressed or pinched, it leads to carpal tunnel syndrome symptoms including pain, tingling, numbness, and weakness in the hand.

Carpal tunnel syndrome comes on gradually. People are mostly likely to notice symptoms first thing in the morning and at night. You may feel like your thumb and first few fingers feel useless and you may experience a pins-and-needles sensation. You may feel the need to shake out your hands and wrists. Tasks like driving, reading a book, or talking on the phone may bring on symptoms. Your hands may feel weak and it might be hard to grasp small objects. Moving your hand may make symptoms less prominent.

One of the signs of carpal tunnel is weakness that may occur as the condition progresses. Weakness affects the thumb and first couple of fingers making it hard to grasp objects or make a fist. It may be hard to perform manual tasks like hold a book, talk on the phone, button a shirt, or hold a utensil.

What does carpal tunnel feel like? People who have carpal tunnel syndrome often complain that their hands feel weak and useless. It may feel like their fingers are swollen even though there is no swelling evident. Some people report that their hands have difficulty differentiating between the sensations of hot and cold.

These causes of carpal tunnel vary on a case-to-case basis. Any number of conditions or injuries that cause swelling or inflammation in the area may lead to compression of the median nerve. The condition is bilateral, but it often begins in the dominant hand. Potential causes of carpal tunnel include fractures, sprains, hypothyroidism, a tumor or cyst in the carpal tunnel, or fluid retention due to menopause or pregnancy. Frequent use of vibrating hand tools may also lead to carpal tunnel.

Carpal tunnel syndrome is three times more likely in females than in males. People are more likely to get carpal tunnel syndrome if they have diabetes, hypothyroidism, gout, rheumatoid arthritis or if they suffer a sprain or fracture of the wrist. Pregnancy and menopause also make the condition more likely.

People in certain professions are much more likely to develop carpal tunnel syndrome than others. Some believe excessive typing may increase the risk of carpal tunnel syndrome, but assembly line workers are three times more likely to get the condition than data-entry personnel. Using vibrating hand tools increases the risk of carpal tunnel syndrome. People who work in manufacturing, finishing, meatpacking, sewing, and cleaning are more likely to report carpal tunnel syndrome than those working in data entry.

If it is untreated, carpal tunnel syndrome symptoms may wax and wane. However, if you do not treat it, symptoms may get worse. You may even get pain that goes as high up as your shoulder. It is possible for muscles in the thumb side of your hand to weaken and atrophy. Muscle atrophy and nerve damage may be permanent if nerve compression goes on for too long.

Pain, numbness, tingling, weakness, and muscle atrophy can be due to symptoms other than carpal tunnel syndrome. These include:

• Thumb or wrist arthritis
• Diabetic neuropathy or other nerve issues
• Ligament, muscle, or tendon injury

Your doctor can perform tests to tell whether your condition is due to carpal tunnel syndrome or some other condition.

There's no one carpal tunnel syndrome test. There are several tests a doctor may do to investigate the underlying cause of your symptoms. With the Tinel test, the doctor will tap on the median nerve to see if it triggers tingling in the fingers. With the Phalen test, you hold the back of your hands together for 60 seconds to see if the activity produces numbness and tingling.

Your doctor needs to perform a nerve conduction study to confirm or rule out a diagnosis of carpal tunnel syndrome. For the test, electric shocks are administered to tell how fast the median nerve transmits the impulse. Electrodes are placed on the hands and wrists. The doctor may perform another test called an electromyography in which a needle is inserted into a muscle to detect median nerve damage and measure electrical activity.

If you have underlying conditions that are contributing to carpal tunnel, such as diabetes or arthritis, treat those first. Your doctor may then advise you to wear a carpal tunnel wrist brace to help rest and immobilize the affected area. The best carpal tunnel brace is one that you will use, especially at night to keep your wrist from bending while you sleep. You can also get carpal tunnel relief by taking nonsteroidal anti-inflammatory medications like naproxen and ibuprofen. Home remedies for carpal tunnel also include the application of cold compresses to decrease pain and soothe the area.

If symptoms are severe, the doctor may recommend oral or injectable corticosteroids for carpal tunnel treatment. Steroids relieve inflammation around the median nerve which eases symptoms. The doctor may choose to inject lidocaine into the area to relieve pain. Diuretics or "water pills" may help, too. If you're interested in home remedies for carpal tunnel, vitamin B6 supplements help some people feel better.

If surgery is needed, it's typically done on an outpatient basis under local anesthesia (meaning you're awake during surgery). The ligament overlying the top of the carpal tunnel is cut to relieve pressure. The healed ligament will allow more space in the carpal tunnel. Sometimes the procedure is done endoscopically, using a tiny camera inserted through a very small incision to guide the procedure.Carpal tunnel release is a common surgery performed to alleviate symptoms of carpal tunnel syndrome. It may be performed on an outpatient basis under local anesthesia. For the surgery, the doctor makes an incision up to 2 inches long along the wrist and cuts a ligament inside the wrist to relieve pressure on the median nerve. Endoscopic surgery is also a possibility to treat carpal tunnel syndrome via small incisions in the wrist.

Many people notice an improvement in carpal tunnel symptoms right after surgery. However, there may be some stiffness and swelling. If that happens to you, raise your hand above the level of your heart and wiggle your fingers frequently to relieve discomfort. The doctor may advise you to wear a carpal tunnel wrist brace for several weeks during healing. Pain, stiffness, and weakness usually resolve within two months. However, complete carpal tunnel surgery recovery time may be up to six months to a year.

A physical therapist can teach you carpal tunnel exercises to stretch and strengthen your wrist. These exercises also help prevent carpal tunnel from coming back. Ask your occupational therapist or physical therapist to show you how to do everyday tasks in such a way that you will not irritate the median nerve. Stick with the exercise program your therapist creates for you. It will help numbness, weakness, and pain from returning.

There is some evidence that chiropractic care can help people with carpal tunnel syndrome when the wrists, upper spine, and elbows are manipulated. Acupuncture helps nerves function better and may help relieve carpal tunnel symptoms. Speak with your doctor before adding acupuncture or chiropractic care to your regimen.

Strong evidence indicates yoga increases grip strength and reduces pain. In a small study, people who did a yoga program consisting of 11 postures for eight weeks fared better than those who wore carpal tunnel splints and those who did not receive any treatment. The yoga program helped participants stretch, strengthen, and balance upper body joints.

Wondering how to prevent carpal tunnel? There's no surefire way to prevent carpal tunnel, but these strategies may help:

• Use ergonomic tools and set up an ergonomic workstations
• Take frequent breaks while working or performing activities
• Maintain good posture
• Stretch your wrists and hands often
• Shake out your arms and legs throughout the day, lean backwards
• Change your position often so you are not in the same position for long periods of time