What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome affects the function of the wrist, hand, and fingers and causes severe pain. Learn more here.
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Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) can occur when the median nerve — a nerve that runs from the forearm to the palm of the hand — is squeezed or pressed at the wrist.
The carpal tunnel is a rigid passageway made of bones, ligaments, and nerves. It gets its name from the small carpal bones, or wrist bones, that are located on the floor of the tunnel. This delicate passageway is located at the bottom of the hand, slightly above the crease where the hand and wrist meet.
An Overview of Carpal Tunnel Syndrome
Carpal Tunnel Pain
Carpal tunnel pain is caused by repetitive movements, which cause inflammation and swelling that puts pressure on the median nerve. However, repetitive movements are not the only cause of this condition.
While factory and office workers are at risk of developing carpal tunnel syndrome due to the repetitive motions involved with their jobs, no current studies have proven that CTS is caused by using a keyboard or computer mouse. Carpal tunnel syndrome causes vary and are not limited to any one group or profession.1
What Are the Symptoms of Carpal Tunnel Syndrome?
Some people are vulnerable to developing carpal tunnel syndrome based simply on biology. Women are three times more likely than men to show signs of carpal tunnel due to the smaller size of their wrists. With less room inside the carpal tunnel, they are more vulnerable to the effects of swelling and inflammation.
Indicators of Carpal Tunnel Syndrome
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- Weakness when gripping objects
- Pain or numbness
- A “pins and needles” feeling in the fingers (sometimes referred to as “carpal tunnel fingers”)
- Swollen feeling in the fingers
- Burning or tingling in the fingers, especially the thumb and the index and middle fingers
- Pain or numbness that is worse at night, also interrupting sleep
Symptoms of carpal tunnel syndrome, including carpal tunnel thumb pain, may mimic other medical conditions as well. See a healthcare provider for carpal tunnel testing if you or a loved one are experiencing any of the above problems.
Who Is At Risk for Carpal Tunnel Syndrome?
Some people are vulnerable to developing carpal tunnel syndrome based simply on biology. Women are three times more likely than men to show signs of carpal tunnel due to the smaller size of their wrists. With less room inside the carpal tunnel, they are more vulnerable to the effects of swelling and inflammation.
People with metabolic disorders such as diabetes and some thyroid conditions are at a higher risk as well. Lifestyle factors, injury, and disease can all lead to carpal tunnel syndrome.
Carpal Tunnel Causes
- Occupations that require using high-force or vibrational tools such as a jackhammer or hand tools.
- Genetics and body structure
- Jobs that require repetitive, strenuous, or extreme wrist motions
- Previous wrist injuries such as fracture or dislocation
- Inflammatory conditions
- Hemodialysis patients (hemodialysis is a treatment for advanced kidney failure)
- Hand or wrist deformities
- Hypothyroidism
- Acromegaly (overactive pituitary gland)
- Arthritic diseases
- Obesity
- Hobbies such as bowling, knitting, and other activities that require repetitive motions of the wrist
- Cysts or tumors in the wrist2
Other Causes of Carpal Tunnel Syndrome
How Often Does Carpal Tunnel Syndrome Cause Hand Pain?
To ensure you’re receiving the correct treatment for your pain, you must first get a correct diagnosis. Some of the other causes of hand pain can be even more severe than carpal tunnel syndrome and require treatment before lasting damage occurs.
De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis causes pain in the tendons located on the thumb side of the wrist. Grasping, turning the wrist, or making a fist will aggravate the condition and may cause pain that is very similar to carpal tunnel thumb pain. In addition to pain, people with De Quervain’s tenosynovitis may have swelling near the thumb.
Sufferers often describe a “sticking” sensation when trying to move the thumb. If left untreated, this condition can limit the range of motion in the wrist. Women and people between the age of 30 and 50 carry a higher risk of developing this condition.4
Trigger Finger
Trigger finger is a common name for a condition known as stenosing tenosynovitis. It is caused by inflammation within the sheath surrounding the affected finger’s tendons.
People whose occupations or hobbies require them to perform repetitive gripping motions are at higher risk of developing trigger finger. In severe cases, it can cause the affected finger to lock in a bent position.
Arthritis
Arthritis is described as swelling and tenderness in the joints. There are two main types of arthritis: osteoarthritis, which involves the breakdown of protective cartilage, and rheumatoid arthritis, an immune system disorder.
Both conditions can cause pain in the wrist and finger joints. Treatments vary according to the type of arthritis. In both cases, the goal of treatment is to reduce symptoms.
How Is Carpal Tunnel Syndrome Diagnosed?
Early diagnosis is important for receiving the appropriate treatments for each individual’s needs. Different causes require different treatment approaches. Carpal tunnel syndrome can cause permanent damage to the median nerve if left untreated.
If you or a loved one are experiencing symptoms of CTS, visit a healthcare provider as soon as possible for a carpal tunnel syndrome test. Several different carpal tunnel tests may be used to confirm a diagnosis.
Your healthcare provider will likely begin with some simple range of motion exercises to check if your range is within normal limits. Swelling from CTS can minimize wrist flexion even when pain isn’t significant.
Tinel’s Sign
This test involves tapping on the median nerve to elicit a response. Your healthcare provider will gently tap the spot near your wrist where the median nerve is housed. If tapping causes tingling, pain, or numbness, you probably have carpal tunnel syndrome.
Wrist Flexion Test (Phalen Test)
Imagine Tests (X-Rays)
Your doctor may order imaging tests to help confirm or rule out a carpal tunnel problem. The carpal tunnel does not show up on an X-ray, but X-rays can show arthritis or bone fractures that may be causing pain. Both ultrasound and MRI diagnostic tests can reveal if the median nerve is compressed and if swelling is present.
Electromyography (EMG)
EMG is a type of nerve conduction study. It is a carpal tunnel test that involves the insertion of several small electrodes along the path of the median nerve.
The needles might be placed from the neck to the hand. Once placed, a mild electrical shock is sent into the needles. Specialized instruments measure the velocity of electricity.
If there is nerve compression, the signal will be disturbed or slowed, showing the presence of carpal tunnel syndrome. To compare results, your healthcare provider may conduct the same test on the side that is not affected.
How Is Carpal Tunnel Syndrome Treated?
The best carpal tunnel treatment depends on what is causing your CTS and how far the condition has progressed. For mild to moderate carpal tunnel symptoms, lifestyle changes are typically recommended. Mild and moderate symptoms are those that have lasted less than ten months.5
Simple actions such as taking frequent breaks from repetitive tasks, avoiding activities that worsen symptoms, and applying ice packs to reduce inflammation may be enough to correct the condition.
Recommended Exercises to Help With Symptoms
These are some exercises to help with pain from CTS. You should aim to do each exercise five to ten times per hand.
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- Shaking It Out: Shaking the hands to bring relief
- Fist to Stop: Make a fist and then open your hand as if making the “stop” signal.
- Fist to Fan: Make a first and then spread the fingers out into a wide fan, stretching them as far as you can.
- Thumb Touches: Touch each fingertip to the tip of your thumb. Repeat several times for each finger.
- Hand Squeezes: Squeeze a soft rubber ball or pair of rolled socks and hold for five seconds.
For more severe and chronic symptoms, exercises and lifestyle changes may not be enough to bring lasting relief. In this case, more aggressive forms of treatment may be recommended.
Exercises and Stretches to Alleviate Pain
Other Treatment Options Available
Immobilization
Wrist splinting is an easy and effective carpal tunnel treatment. Splinting keeps the wrist still and is often recommended for relieving carpal tunnel symptoms that worsen at night.
Even though it is only worn at night, a splint may also help decrease daytime symptoms. Pregnant women and others who prefer to avoid medications may prefer wrist splinting to other solutions.
Medication
You can use several medications to relieve carpal tunnel pain. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can sometimes bring short-term relief. However, there is no evidence that these medications improve carpal tunnel syndrome.
Corticosteroids are a group of synthetic drugs that mimic hormones produced in the adrenal glands. Prednisone, cortisone, and methylprednisolone are some of the most commonly prescribed types of corticosteroids.
These medications are not a cure for carpal tunnel syndrome, but they provide relief from the inflammation that compresses the median nerve. Injectable corticosteroids are typically considered more effective than oral forms of medications. If carpal tunnel pain is caused by arthritis, medications to treat arthritis may be beneficial.
Surgery
Open Surgery
In open surgery, a doctor makes an incision in the palm of the hand directly over the carpal tunnel. Cutting into the carpal tunnel allows the surgeon to cut through the ligament, freeing the nerve from compression. This method is often cheaper.
Endoscopic Surgery
Endoscopic surgery involves a telescope-like device fitted with an endoscope that lets the surgeon see into the carpal tunnel. In some cases, an ultrasound is used to guide the surgeon’s cutting tool instead of a camera. Endoscopic surgery may be preferred because patients experience less pain in recovery. This surgery results in a faster recovery and less scarring.
Surgery Considerations
Both are equally effective for relieving carpal tunnel thumb pain and other symptoms. A full recovery will take a month or more. Patients must follow all recovery protocols, including not lifting heavy objects or performing strenuous movements until the surgical wound is completely healed.
Occupational and physical therapy are recommended as part of post-surgical care. The success rate of carpal tunnel surgery is high. A study published by the University of Michigan Health states that both the open and the endoscopic procedures have a success rate of 75% to 95%.6
Tips for Carpal Tunnel Prevention
- Sleeping with your wrists held straight (use braces for immobilization if needed)
- Keeping wrists straight when using tools
- Avoiding flexing and extending your wrists repeatedly
- Decreasing repetitive or strong grasping with the wrist in a flexed position
- Taking frequent rest breaks from repetitive activities
- Performing conditioning and stretching exercises before and after activities.
- Changing your computer mouse
Other Tips to Alleviate Carpal Tunnel Pain
It is also crucial to monitor and properly treat any medical conditions linked to CTS. Make sure blood pressure and blood sugar levels are kept within a healthy range. Avoid foods that can cause inflammation and consider following an anti-inflammatory diet.7
Does Carpal Tunnel Syndrome Have a Long Recovery?
For those with mild to moderate carpal tunnel symptoms, maintaining good health and performing recommended exercises can help relieve symptoms for long periods. However, since there is no cure for carpal tunnel syndrome outside of surgery, symptoms may flare up with overuse.
Moving Forward with Carpal Tunnel Syndrome Diagnosis
If the condition is caused by genetics or another health problem such as arthritis, getting treatment for those conditions provides the best chance of lasting recovery.
Patients who opt for surgery have the greatest chance for complete recovery. However, it can take as many as twelve months to notice an improvement in carpal tunnel pain.
With careful monitoring and the right medical care, you can find lasting relief and minimize the recurrence of carpal tunnel syndrome symptoms.
Conclusion to Carpal Tunnel Syndrome Synopsis
Resources
- https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0685-0
- https://www.ninds.nih.gov/health-information/patient-caregiver-education/fact-sheets/carpal-tunnel-syndrome-fact-sheet
- https://www.verywellhealth.com/carpal-tunnel-syndrome-causes-risk-factors-2549308#citation-6
- https://www.mayoclinic.org/diseases-conditions/de-quervains-tenosynovitis/symptoms-causes/syc-20371332
- https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/diagnosis-treatment/drc-20355608
- https://www.uofmhealth.org/health-library/hw212492
- https://www.healthline.com/nutrition/anti-inflammatory-diet-101#:~:text=An%20anti-inflammatory%20diet%2C%20along%20with%20exercise%20and%20good,triglyceride%20levels%205%20Improvement%20in%20energy%20and%20mood
