Carpal Tunnel Syndrome

What Is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is a neurological condition that affects the hands and fingers. Caused by compression of the median nerve in the wrist, its symptoms include numbness, pain, tingling, and weakness. Trauma to the hands and wrist from an accident can cause the type of nerve compression that results in this condition. Repetitive hand motions over a long period of time can also cause compression of the median nerve resulting in this condition.

A common misconception about carpal tunnel syndrome is that it is only a repetitive stress-type injury. In fact, however, traumatic injury to the wrist is a common cause of acute carpal tunnel syndrome. When trauma to the hands and wrist occurs, swelling and scar tissue can compress the median nerve causing this condition.

The Anatomy of the Carpal Tunnel

The carpal tunnel is a passage surrounded by bones and the transverse carpal ligament. The tunnel consists of the median nerve and nine flexor tendons. The median nerve provides sensation to the thumb, index, and middle finger along with a part of the ring finger. It also powers the movement of the hand and thumb.

What are the Symptoms of Carpal Tunnel Syndrome?

The symptoms of carpal tunnel syndrome vary according to the severity of the condition as well as its cause. Usually, patients will initially report changes in sensation involving the fingers. As the condition progresses, complaints of weakness and difficulty with movement of the fingers are also common.

The most common symptoms of this condition include:

• Pain (burning-like), tingling, and numbness of the thumb, index finger, middle finger, and the radial portion of the ring finger. The median nerve does not power the fifth finger or pinkie. Instead, the ulnar nerve powers the pinkie, and as a result compression of the median nerve does not affect the pinkie;
• Weakness or difficulty in controlling the affected hand usually worsened upon activity;
• Possible shock-like sensations in the affected hand;
• Radiation of pain in the forearm or even the shoulder.

During the condition’s initial phase, patients will usually experience pain mostly at night. Patients often report that shaking the hand vigorously relieves pain although this is usually followed by hand stiffening. As the condition progresses, symptoms begin to be present during the day when performing repetitive activities. Severe cases can result in ongoing symptoms and muscle atrophy.

How to Diagnose Carpal Tunnel Syndrome

Physical examination of the patient’s hand and wrist is the initial step in the diagnosis of carpal tunnel syndrome. Scratches, scars, or bruising in these areas may indicate an injury-related cause of the condition.

Your doctor will perform two important tests to evaluate you for carpal tunnel syndrome: Tinel’s sign test and Phalen’s maneuver. A positive Tinel’s sign occurs when there is tingling or pain in certain areas of your hand in response to your doctor tapping your wrist. A Phalen’s maneuver is positive when flexing the wrist causes median nerve symptoms.

Your doctor may also perform vibration, two-point discrimination, and monofilament testing to assess sensory symptoms.

In addition to taking a history and conducting a physical examination, your doctor may order an electrodiagnostic study to help diagnose your condition called Electromyography / Nerve Conduction Velocity Study (EMG/NCV Study). This is an electro-diagnostic study used to test for muscle and nerve pathology. This test can effectively help diagnose carpal tunnel syndrome by assessing the activity of the median nerve, and the muscles it powers.

What Treatment is Available for Carpal Tunnel Syndrome?

Surgery is usually not necessary for mild and moderate carpal tunnel syndrome. Instead, treatment may include:

• Modifying wrist movement with good hand ergonomics;
• Minimizing repetitive hand movements;
• Use of a hand brace or wrist splint;
• Ultra-sound or laser therapy;
• Non-steroidal anti-inflammatory drugs;
• Oral or intravenous corticosteroids.

What is Carpal Tunnel Release Surgery?

Surgery may be necessary when symptoms are severe and electrodiagnostic testing confirms the diagnosis. The most common surgery performed for this condition is carpal tunnel release surgery. This surgery involves manipulating the carpal ligament to widen the space within the carpal tunnel. This procedure is usually performed by an orthopedic surgeon.

Carpal tunnel release surgery is usually an outpatient procedure and can be performed under local or general anesthesia. After surgery, a patient should elevate the hand and move the fingers to minimize swelling and stiffness. Swelling and pain are common after the procedure, but these do lessen in time. Total recovery is gradual and may take several months.

Your doctor will usually prescribe a wrist brace after surgery to help protect your wrist. Further, physical therapy and periodic followup with your surgeon are important to a quick and safe recovery.