Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a common condition that causes pain, numbness, and weakness in the hands and wrist. It occurs when there is increased pressure on a nerve called the median nerve. This nerve provides sensation to the thumb, index and middle fingers, and to half of the ring finger. The small finger (the “pinky”) is typically not affected. The median nerve also provides strength to some of the muscles at the base of the thumb.
What is the carpal tunnel?
The carpal tunnel is a narrow canal in the wrist. The bottom and sides of the tunnel are formed by a semi-circle of bones called carpal bones. A strong tissue, called a ligament, forms the top of the tunnel. The median nerve and tendons pass through this narrow space. (The tendons are “rope-like” structures that connect muscles in the forearm to bones in the hand.) Tendons allow the fingers and thumb to bend and straighten. Conditions that further narrow the carpal tunnel or cause the tendons that pass through this tunnel to swell cause carpal tunnel syndrome by compressing the median nerve.
Who is most like to get carpal tunnel syndrome?
People most at risk are those with jobs or activities that involve repetitive finger use, especially those associated with high force, long-term use, extreme wrist motions, and vibration.
Other things that contribute to the development of carpal tunnel syndrome include:
- Heredity (smaller carpal tunnels can run in families).
- Wrist fracture and dislocation.
- Hand or wrist deformity.
- Arthritic diseases such as rheumatoid arthritis and gout.
- Thyroid gland hormone imbalance (hypothyroidism).
- A mass (tumor) in the carpal tunnel.
- Older age.
Myths and Truths about carpal tunnel syndrome
Myth: Most hand pain is caused by carpal tunnel syndrome. Truth: It’s true that carpal tunnel syndrome is a common condition. However, it does have a set of symptoms that are different from many other sources of hand pain.
Even so, there are several other hand pain conditions similar to, or associated with, carpal tunnel syndrome. One of these is de Quervain’s tendinosis. This is an inflammation that affects the base of the thumb. Another inflammatory disorder is called trigger finger. Trigger finger causes soreness at the base of the finger or thumb. It also causes pain and stiffness when bending the fingers and thumb.
Myth: Carpal tunnel syndrome is a condition of the 90s. Truth: It was first described in the mid-1800s. The first surgery for release of the carpal tunnel was done in the 1930s. It is a condition that has been well recognized by orthopaedic surgeons for over 40 years.
Myth: Carpal tunnel syndrome occurs only in office workers or factor assembly line workers. Truth: Many patients with carpal tunnel syndrome have never done office work or worked on an assembly line.
Anyone can get carpal tunnel syndrome, but it is unusual before age 20. The chance of getting carpal tunnel syndrome increases with age. Women have a slightly higher chance of getting carpal tunnel syndrome. It affects people who use their wrists and hands repeatedly at work and at play.
Myth: It takes a long time to recover from surgery to treat carpal tunnel syndrome. Truth: The bandage that covers the stitches after surgery can be removed in a few days. The hand can then be used for light activities. Making a fist is encouraged. Full range of finger motion and symptom relief is usually seen within 2 weeks after stitches have been removed. Some surgeons prefer to splint the wrist for 2 weeks or so after surgery. You can usually return to most activities by 6 weeks. Return to work depends on many factors, such as type of work, how much control you have over your work, and workplace equipment.
Myth: Surgery usually doesn’t work. Truth: Surgery has a high success rate, over 90%.
The tingling sensation and waking up at night is usually relieved fairly quickly, as is any pain that is coming from the carpal tunnel. Numbness may take longer to be relieved, even up to 3 months. Surgery won’t help if carpal tunnel syndrome is the wrong diagnosis. When the carpal tunnel syndrome has become severe, relief may not be complete. There may be some pain in the palm around the incisions that can last up to a few months. Other after-surgery pain may not be related to carpal tunnel syndrome. Patients who complain of pain or whose symptoms remain unchanged after surgery either had severe carpal tunnel syndrome; had a nerve that was not completely released during surgery; or did not really have carpal tunnel syndrome. Only a small percentage of patients do not gain complete relief from symptoms.
Myth: Carpal tunnel syndrome frequently comes back after surgery. Truth: Recurrences are unusual.
What are the symptoms of carpal tunnel syndrome?
Symptoms usually begin slowly and can occur at any time. Early symptoms include numbness at night, tingling, and/or pain in the fingers (especially the thumb, index, and middle fingers). In fact, because some people sleep with their wrists curled, nighttime symptoms are common and can awake people from sleep. These nighttime symptoms are often the first reported symptoms. Shaking the hands helps relieve symptoms in the early stage of the condition.
Common daytime symptoms are tingling and decreased feeling in the fingertips. Patients also report difficulty handling small objects, grasping a steering wheel to drive, holding a book to read, writing, and using a computer keyboard.
As carpal tunnel syndrome worsens, symptoms become more constant. Weakness in the hand, inability to perform tasks that require delicate motions (such as buttoning a shirt), and dropping objects begin to occur. In the most severe condition, the muscles at the base of the thumb visibly shrink in size.