Repetitive hand motions, wrist anatomy, and even some health problems can lead to a painful condition known as Carpal Tunnel Syndrome (CTS).
The carpal tunnel, located in the wrist, is a narrow passage about an inch wide that is lined with ligaments and small bones referred to as carpal bones.
Identifying the early signs and causes of this condition can help people avoid painful symptoms and seek appropriate and effective treatment approaches.
A proper diagnosis of carpal tunnel syndrome is important because it is sometimes confused with wrist tendonitis that shares similar symptoms.
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome occurs when the median nerve that runs from the palm of the hand up into the forearm is squeezed or compressed as it travels through the wrist.
It is the median nerve that provides feeling to the palm side of the thumb, index finger, middle finger, and part of the ring finger.
Irritated tendons and ligaments in the carpal tunnel can swell and thicken, which places added pressure on the median nerve. This may lead to a number of irritating symptoms, such as weakness, numbness, tingling, and even pain.
Left untreated, the symptoms of carpal tunnel syndrome can interfere with normal functions, like physical activity and possibly sleep.
Carpal Tunnel Syndrome Causes
The exact cause of carpal tunnel syndrome for each person can sometimes be difficult to identify and it is often a combination of different factors.
Generally, though, the issue is not with the median nerve itself, but with the thickening of the carpal tunnel, which is placing pressure on the nerve.
Health issues, such as overactive pituitary glands, underactive thyroid, obesity, and rheumatoid arthritis can lead to CTS.
Fluid retention during pregnancy or menopause can cause the condition, as well as a cyst or tumor inside the carpal tunnel.
Other causes of carpal tunnel syndrome can include:
- Trauma or injury to the wrist
- Mechanical issues in the wrist brought on by physical anatomy
- Repeated use of vibrating hand tools, like sanders, drills or saws
- Years of working on a computer keyboard for long hours at a time
- Overuse or repetitive movements that place stress on the wrist
- Some types of neuropathy
- Sports that involve wrist movements and grip strength like tennis, golf, gymnastics, weight lifting, and cycling
Women are at a greater risk of developing carpal tunnel syndrome, as well as those with diabetes or other medical disorders that affect the body’s nerves.
Workplace factors can also place people at a greater risk, especially those who work in manufacturing, assembly line jobs, sewing, cleaning, and the like.
Carpal Tunnel Syndrome Symptoms
Early carpal tunnel syndrome symptoms usually start gradually with tingling or numbness, generally in the thumb, index, and middle fingers.
The dominant hand usually presents with the worst symptoms. It’s also common for the symptoms to first appear at night in one or both hands.
A person suffering from CTS might wake up in the middle of the night from tingling or numbness, feeling as if one or both hands are asleep.
Additional symptoms of carpal tunnel syndrome may include:
- Numbness or tingling during the day during activities like talking on the phone, reading a book or newspaper, or even driving
- Weakness in the hand that makes it difficult to grasp objects
- Fingers that feel dull, useless and swollen despite no outward signs of inflammation
- A burning sensation in the fingers and thumb
- Pain and soreness in the hand, wrist, and sometimes forearm
- In severe cases, an inability to discern between hot and cold to the touch on the affected fingers
Being able to identify the initial symptoms of carpal tunnel syndrome is important for getting treatment early and avoiding further damage to the carpal tunnel.
Carpal Tunnel Syndrome Treatment
Diagnosis of CTS involves a physical examination as well as a discussion of recent activity, medical history, and symptoms.
Physicians will usually review x-rays, an ultrasound, or an MRI in order to get a closer look at the carpal tunnel and identify any compression being placed on the median nerve.
Certain types of tests like the wrist flexion or Phalen test might be used to help confirm the diagnosis.
Conservative, non-invasive treatment approaches are always the first step for recovery.
Carpal Tunnel Syndrome Treatment Methods Include:
1. RICE Method
The RICE Method involves Rest, Ice, Compression, and Elevation of the injured area.
- Rest helps decrease inflammation and pain from carpal tunnel syndrome by reducing activity that causes the symptoms
- Ice minimizes the inflammation and swelling and may help to ease the pain
- Compression from a bandage wrap or strap stabilizes the hand and wrist to decrease swelling and increase healing
- Elevating an injury above the heart if possible may reduce swelling
2. Avoid Activities That Cause Pain or Symptoms
Avoiding activities that cause CTS pain or symptoms is similar to resting the injury to give it time to heal in the RICE Method. For professional athletes or office workers, it may be difficult to take time off from playing or working if it is a profession that is causing the condition.
For amateurs and hobbyists, avoiding sports that cause pain and symptoms for a short time may help. Computer gamers or internet junkies should stay off of the computer until the pain subsides.
3. Brace or Splint
If it is not possible to stop working or playing sports, a brace or splint will help stabilize the carpal tunnel and may ease the symptoms for people who need to continue doing the activity that is causing CTS.
Wearing a brace or splint on the wrist at night will provide stability while sleeping to minimize movement and pressure on the median nerve to promote healing.
4. Anti-Inflammatory Medications
Over-the-counter, nonsteroidal, anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve) can help lessen the pain and swelling caused by inflammation.
5. EPAT Therapy (Shockwave)
EPAT Therapy, formally known as Extracorporeal Pulse Activation Technology, delivers short bursts of impulse pressure waves to the carpal tunnel, which increases blood flow and decreases inflammation to ease pressure on the median nerve.
This technique is also called Shockwave Therapy (Extracorporeal Shock Wave Therapy ESWT) and is a non-invasive treatment approach that has shown to speed up healing time.
There is no scarring or risk of infection, like with surgery, and EPAT / Shockwave treatments can sometimes be delivered while a person continues to work or perform other needed functions while treating CTS.
6. Physical Therapy
Physical Therapy can be used at the first signs of carpal tunnel syndrome as well as after surgery if it becomes necessary.
There are a variety of stretches that may be helpful such as median nerve gliding or nerve flossing in combination with other treatments. These should always start out gradually and in moderation to see if they help, since it’s possible they may irritate the injury even more for certain individuals.
7. Corticosteroid Injections
Corticosteroid or cortisone injections directly into the wrist may be used to decrease swelling and relieve pressure on the median nerve.
However, not everyone is eligible for these injections and repeated shots can damage other healthy tissue in the surrounding area.
8. Carpal Tunnel Syndrome Surgery
Carpal tunnel syndrome surgery, known as carpal tunnel release, is sometimes necessary when the condition becomes severe and conservative treatment methods have not been effective.
This type of surgery involves severing or “releasing” the transverse carpal ligament around the wrist and palm to decrease pressure on the nerves in the tunnel.
While surgery can be an effective treatment, there is always a risk associated with the procedure that should be discussed with the physician. It will also require greater downtime and longer recovery as a person heals from the procedure.
One of the best ways to avoid carpal tunnel syndrome is to practice prevention techniques before it ever occurs.
Carpal Tunnel Syndrome Prevention Techniques
Here are some effective CTS prevention techniques.
- Avoid repetitive wrist movements whenever possible
- Take frequent breaks to rest the hands, wrists, and fingers
- Keep the wrists straight, especially at night when sleeping
- Wear a wrist brace during the day or when sleeping
If CTS symptoms appear, take a break from activities that are causing the symptoms and use some of the carpal tunnel syndrome treatment methods outlined above.
On the chance that symptoms persist or become worse, see a doctor or hand specialist to get a diagnosis before the injury progresses.
Carpal Tunnel Syndrome Illustration Author: Bruce Blaus Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.