The carpal tunnel is a tapered passage formed by the transverse carpal ligament and small wrist bones called the carpal bones. Only about an inch wide, the carpal tunnel houses the median nerve, one of the prominent nerves in the hand. It also contains the nine flexor tendons that allow the fingers to bend.
Rigid boundaries do not allow the carpal tunnel to expand or stretch so if one of the flexor tendons becomes inflamed by injury or repetitive motion, it compresses the median nerve. Over time, this constriction can cause pain and numbness in the wrist which often affects the motion of the hand.
Anyone can develop narrowing in the carpal tunnel, but women and the elderly are more likely to be affected. Many factors can reduce the available space in the carpal tunnel and constrict the median nerve including:
- Heredity — Some people may have reduced space in the carpal tunnel due to genetics.
- Wrist trauma — An injury like a wrist sprain or fracture could cause swelling and place pressure on the tendons.
- Rheumatoid arthritis
- Mechanical problems in the wrist
- Overuse of the wrist — Repetitive wrist motions can aggravate the tendons and cause inflammation
- Using vibrating hand tools
- Hormonal changes – Fluid retention, especially during pregnancy or menopause, can cause swelling
- Cyst or tumor
- Overactive pituitary gland or underactive thyroid — Imbalances in the endocrine system are often associated with carpal tunnel syndrome
Common symptoms of carpal tunnel syndrome include:
- Tingling, burning, numbness or itching in the fingers and palm (especially the thumb, index and middle finger)
- Shock-like sensations that radiate through the hand
- Decreased grip strength or dropping objects
- Sensation of swollen fingers, even if no swelling is visible
- Sleeping with wrists flexed
- Feeling the need to shake out the wrists after sleep
- Inability to sense hot and cold in the affected hand
Carpal tunnel syndrome usually worsens over time, so it is essential to see a doctor for prompt diagnosis and treatment.
Your doctor may recommend:
- Bracing or splinting: Wearing a brace or a splint at night will keep your wrist stable while you sleep. Maintaining a neutral position takes pressure off the median nerve and reduces inflammation.
- Avoiding specific activities: Sports or repetitive movements can exacerbate the condition. Try to rest and avoid strenuous exercise.
- Nonsteroidal anti-inflammatory drugs: Ibuprofen and other NSAIDs can reduce inflammation and create space in the carpal tunnel.
- Steroid injection: Corticosteroid injections are often used to diagnose carpal tunnel syndrome. They are quick and effective in relieving pain and tingling, but the relief is only temporary. Because cortisone can weaken tendons, repeated treatments are not recommended.
- Physical therapy: Nerve gliding exercises can help ease the movement of the median nerve within the carpal tunnel.
- Surgery: Sustained pressure on the median nerve can result in permanent damage, so your doctor may recommend surgery to remove stress from the median nerve.
Recovery time for carpal tunnel syndrome depends on the severity of the condition. Mild cases can often heal within a few weeks with a physician-prescribed regimen of rest, splinting, and anti-inflammatory medication.
If surgery is necessary, the affected hand will be restricted from any lifting or activity for at least four to six weeks. The amount of recovery time the patient's age, general health, the severity of symptoms, and the length of time symptoms have been present.
If you are experiencing pain, tingling and restricted movement of your hand or wrist, contact the Surgery Center of Allentown to make an appointment with one of our board-certified orthopaedists. On the day of your visit, be prepared to tell your doctor:
- The location of your pain
- When the pain began and how long it has lasted
- Pertinent background information like an injury or event that may have initiated your symptoms
- Previous treatments you have tried (rest, splint or anti-inflammatory medication)
Please bring a list of your current medications (including dosage) and any specific questions for your doctor. During your appointment, your orthopaedist will collect some medical information, assess your wrist and discuss treatment recommendations. You may want to ask some of the following questions:
- What treatment options are available for my condition?
- Can we begin with the least invasive treatment and progress to more involved procedures later?
- Do I need surgery? If so, what are the benefits and drawbacks of scheduling surgery now versus waiting until a future date?
- What happens during the procedure?
- What are the side effects of this treatment?
- Are there any associated risks or complications?
- How long will it take for me to heal?
- Will I need physical therapy? If so, how long will I have to be in treatment?