The carpal tunnel is formed by structures of the wrist:Wrist Pain

  • 8 wrist bones form an arch; the ends are connected with a ligament, creating a tunnel-shaped passageway.
  • Tendons that flex the fingers and the median nerve pass through this tunnel.
  • The tendons are covered with synovium, a thin, slippery membrane that allows the tendons to slide easily.

What causes it?

  • Carpal tunnel syndrome (CTS) occurs when pressure on the nerve within this space causes numbness and pain. Pressure comes from inflammation or retaining fluid, like in pregnancy, or holding your wrist in a folded position for a long time, pinching the nerve.
  • The goal of treatment is to relieve pressure from the nerve, take away symptoms, preserve hand function and prevent permanent nerve damage.

Symptoms can vary:

  • Classic: numbness, tingling or pain in the thumb, index and middle fingers, especially at night or with prolonged gripping while driving or holding a book.
  • Ache or burning in the hand or up the forearm, sometimes to the shoulder
  • Weakness or loss of coordination of your fingers and thumb; dropping things
  • In severe cases, the muscles in the palm will shrink (atrophy)
  • Overuse, misuse or an injury to your wrist/hand can cause CTS.
  • Age-related wear and tear in nearby arthritic joints or tendonitis can flare up along with the nerve pain.

Evaluation:

  • History: What are your symptoms, any prior injury, pain patterns, activities that Carpal Tunnel Syndromeaggravate the problem? Is it your dominant or non-dominant hand? How does it affect your job or other important tasks? Treatments you’ve already tried, and if they helped. Your general health and medicines you take.
  • Physical Exam: How do you and your arms, wrists and hands look and move? Tenderness, swelling, deformity or discoloration in a specific structure.
  • Tests: X-rays define the bony structures and condition of the joints. You may need a consultation with a neurologist and a nerve test/electromyogram (EMG) if your diagnosis isn’t certain.

Treatment:

  • There are different treatments available to help relieve CTS. Each is designed to correct the cause: relieve pressure on the nerve.
  • Start simple, and then add something else if needed. You can cut back when you start to feel better.
  • Turn the page for details…
  • Wear a brace to support your wrist in a straight line.
      • At night so you don’t curl your wrists while you sleep.
      • While doing heavy or repetitive work.
      • There are a lot of styles on market; big drugstores and Wal-Mart have a good selection. Any one that’s comfortable, keeps your wrist straight and lets you move your fingers is a good one.
      • Buy several: one for the car, workshop, nightstand and sewing basket so it’s there when you need it.
  • Exercises: keep your wrists/hands limber and move excess fluid out
      • Take breaks for 1-2 minutes, every 30 minutes to rest and stretch
      • Roll your neck and shoulders; bend and straighten your elbows
      • Squeeze a soft rubber ball and release, 20 times, 3 times a day
      • Elevate your hands above shoulder level so swelling drains out
  • Medicine:
      • Anti-inflammatory pills like Advil (ibuprofen) OR Aleve (naproxen) as needed, if you can take them.
      • Vitamin B-6: Some patients get relief by taking vitamin B6 50 mg, twice a day. It can take up to 6 weeks to notice an improvement. To learn more, visit http://ods.od.nih.gov/factsheets/vitaminb6.asp.
  • Cortisone Shot: shrinks inflamed tissue that’s crowding the tunnel.
      • Works best if you’ve suddenly developed carpal tunnel symptoms from an unusually busy project.
      • Could give temporary relief and buy time until you can schedule surgery
      • You could have 1 or 2 shots in a year, but need surgery to decompress the nerve and solve the problem if numbness and pain keep coming back
  • Surgery
      • If your pain/numbness continues despite the brace and a shot, or if your EMG indicates severe CTS, you need surgery to prevent permanent nerve damage.
      • Outpatient, with local anesthesia. Some patients need sedation, you may not. We’ll talk about what’s best for you.
      • Takes about 10 minutes
      • A small incision in the crease of your palm divides the ligament and relieves pressure on the nerve.
      • Most patients’ numbness is gone within a day or two.
      • Soreness around the scar can last for several weeks or months. It may take several months for your hand to regain normal strength and endurance.
      • If you have had severe carpal tunnel syndrome for many years, there may be some permanent weakness
      • Recurrence after surgery is rare.
      • Time out of work for surgery depends on the type of work that you do. Patients with a desk job can go back to the office within a day or so, with minimal use of the hand at first. If you have a physically heavy job, or need to use your hand for repetitive work, you be out for up to 6 weeks. Talk to your employer about this, and ask about returning to work with restrictions for the first few weeks.