The carpal tunnel is the narrow passageway in the wrist through which the median nerve and tendons pass. Swelling of the tissues within the tunnel can squeeze the median nerve, causing hand or arm pain, numbness, tingling, and, if not treated, loss of function. Symptoms of carpal tunnel syndrome usually start slowly and intensify over time.
What causes it?
Abnormal pressure on the median nerve that leads to symptoms of carpal tunnel syndrome can result from a number of factors:
- Congenital predisposition
- Repetitive hand use
- Injury such as sprain or fracture
- Activities involving prolonged periods of extreme flexion/extension
- Health conditions including pregnancy, diabetes, thyroid disease, rheumatoid arthritis
How do you know you have it?
You might have carpal tunnel syndrome if you experience:
- Pain, burning, numbness, or tingling, often affecting fingers other than the pinky
- Tingling or pain radiating from forearm to shoulder
- Occasional bursts of pain affecting thumb, index, middle, and ring fingers
- Hand weakness or dexterity issues increasing the difficulty of fine movements (using utensils, buttoning a shirt)
How we fix it
OSI board-certified orthopedic specialists can treat your carpal tunnel syndrome. Your physician will ask about your medical history and have you fully describe any symptoms you have been experiencing. Following a thorough examination of the hand and wrist, a number of tests may be administered as part of the diagnosis:
- Tinel’s Test for nerve damage (tapping the inside of your wrist over the median nerve)
- Test for numbness and tingling (holding wrists in flexed position)
- Test for fingertip and hand sensitivity
- Test for weakness/atrophy in the muscles around the base of your thumb
Additional diagnostics could include:
- Electromyogram (EMG): An EMG evaluates the electrical activity produced by muscles and can reveal whether you have muscle or nerve damage
- Ultrasound: High-frequency sound waves can detect compression in the median nerve
- X-rays: X-rays may be used to exclude other causes of symptoms
- MRI: An MRI can help determine the presence of abnormal tissues that might be impacting the median nerve or if there are issues with the nerve itself (scarring resulting from an injury)
Often, carpal tunnel symptoms are relieved without the need for surgery. Non-surgical treatments include:
- Medications: Nonsteroidal medications (NSAIDs) like ibuprofen can relieve inflammation and pain
- Steroidal injections: Cortisone shots may relieve symptoms for a period of time
- Activity Modification: Job and/or leisure activities that potentially aggravate symptoms may necessitate changes or a reduction of these activities. Ergonomic modifications at work may also be necessary.
Depending on the severity of your symptoms, a surgical option known as carpal tunnel release might be recommended. There are two techniques of carpal tunnel release; both seek to relieve pressure on the median nerve by increasing the size of the tunnel:
- Open carpal tunnel release: Through a small incision in the palm of your hand, your physician will divide the transverse carpal ligament to increase tunnel size and reduce pressure on the median nerve
- Endoscopic carpal tunnel release: Similar to an open release procedure, your physician uses a miniature camera, or endoscope, to see inside the hand and wrist