Carpal Tunnel Syndrome

Carpal tunnel syndrome

Carpal tunnel syndrome is a common condition where too much pressure of the median nerve at the wrist causes pain, numbness, and tingling of the hand and fingers. The median nerve supplies feeling to the thumb, index finger, middle finger, and half of the ring finger. The median nerve also controls the muscles in the hand at the base of the thumb.

If you think you have carpal tunnel syndrome, it is important to get evaluated and treated by an orthopedic specialist because carpal tunnel related nerve damage can become permanent over time.

What is the carpal tunnel?

The carpal tunnel is the area in the wrist that contains the median nerve along with structures that go from the forearm to the fingers such as the flexor tendons and blood vessels. The median nerve supplies feeling to the thumb, index finger, middle finger, and half of the ring finger. The median nerve also controls the muscles in the hand at the base of the thumb.

What causes Carpal tunnel syndrome?

Too much pressure of the carpal tunnel can be caused by swelling from injury (sprains, fractures, dislocations, etc.), tendonitis, arthritis, and fluid retention during pregnancy.

What are the Signs and Symptoms of carpal tunnel syndrome?

  • Hand Numbness and/or tingling
  • Waking up during the night with numbness and/or tingling in the fingers.
  • Pain or aching in the wrist.
  • Dropping objects or feeling clumsy.
  • Difficulty with fine movements such as buttoning buttons or picking up small objects like coins or paper clips.
  • Weak grip strength.

How do you diagnose carpal tunnel syndrome?

Diagnosing carpal tunnel syndrome begins with a thorough discussion and physical exam by your orthopedic physician. X-rays are usually taken to rule out arthritis and if there has been an injury such as a fracture.

Your doctor should rule out other conditions that can cause numbness and tingling in the hands such as diabetes, thyroid problems, some vitamin deficiencies, and pinched nerves in the neck or elbow.

The following tests may be requested in order to confirm carpal tunnel syndrome.

Tinel's Test
  • Nerve conduction study/Electromyogram (EMG)
    A nerve conduction study/EMG is a test that may be performed in the hand specialist’s office, or may require a referral to a neurologist or other specialist. The test uses electrical impulses to determine where a nerve may be compressed or to determine whether there is any neuropathy that may be caused by an underlying condition.
  • Blood tests
    Return to the primary care provider may be recommended for further evaluation and blood testing that can rule out things like diabetes and thyroid problems that may mimic carpal tunnel syndrome symptoms.

What are Common Treatments for carpal tunnel syndrome?

Diagnosing carpal tunnel syndrome begins with a thorough discussion and physical exam by your orthopedic physician. X-rays are usually taken to rule out arthritis and if there has been an injury such as a fracture.

Your doctor should rule out other conditions that can cause numbness and tingling in the hands such as diabetes, thyroid problems, some vitamin deficiencies, and pinched nerves in the neck or elbow.

The following tests may be requested in order to confirm carpal tunnel syndrome.

  • Activity modifications such as adjusting work stations for ergonomics and padding hard surfaces to prevent pressure on the wrists.
  • Wearing a wrist brace at night or during physical activity.
  • Hand exercises
  • Anti-inflammatory medications
  • Anti-inflammatory medications
  • Steroid or “cortisone” injections into the carpal tunnel can reduce inflammation around the median nerve
  • CBD – CBD is a natural, nonsurgical way to help treat joint pain and inflammation
  • Carpal tunnel Surgery

What are the surgical treatments for carpal tunnel syndrome?

Surgical treatment for carpal tunnel syndrome is called a “release” because the transverse carpal ligament that covers the carpal tunnel is cut to release the pressure inside of the tunnel. Endoscopic and open carpal tunnel release are procedures performed by hand specialists. Endoscopic carpal tunnel release is a minimally invasive, muscle preserving procedure that releases the carpal tunnel by inserting a small camera into the hand through small incisions. Open carpal tunnel release requires a larger incision and will cut the muscles over the carpal tunnel. Open carpal tunnel surgery is more invasive and takes longer to recover from.

What to expect after endoscopic carpal tunnel surgery?

Endoscopic carpal tunnel surgery is a very successful, minimally invasive way to release pressure away from the carpal tunnel. Patients that have endoscopic carpal tunnel surgery can often return to work and physical activities sooner than if they had an open carpal tunnel release. The night pain is gone almost immediately. Symptoms such as weakness with grip or numbness at the finger tips will improve from the beginning; however, it may take weeks or months to recover completely.

In most cases, you begin moving and using the hand right away. If uncomfortable, heavy lifting should be avoided for up to 4 weeks or until the discomfort resolves. Soreness may last for several weeks to months after surgery; this is mostly dependent on how severe the nerve compression was before surgery. Hand therapy may be helpful or even needed.

**Disclaimer: Treatment recommendations may vary depending on your true diagnosis. Always follow the recommendations of your orthopedic provider.

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