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Understanding Carpal Tunnel
The carpal tunnel is a narrow tunnel in your wrist. The bottom and sides of the tunnel are formed by carpal bones and the top of the tunnel is covered by a strong tissue called the transverse carpal ligament. The tunnel protects the median nerve which runs from the forearm to the palm of your hand. The median nerve controls feeling in the palm side of the thumb, index finger, and middle finger as well as the muscle at the base of the thumb. The tendons that help bend your fingers, flexor tendons, also travel through the carpal tunnel.
Carpal tunnel syndrome occurs when swollen or inflamed tissues in the carpal tunnel press against the median nerve. This pressure may result in pain, weakness, or numbness in the hand and wrist, that extends up the arm.
Symptoms usually begin gradually, with burning, tingling, or numbness in the palm of the hand and the fingers. Often the symptoms will feel more intense during the night, since many people sleep with curled wrists.
As symptoms worsen, you will feel frequent tingling and pain during the day. Over time, it may become difficult to make a fist, grasp small objects, or perform routine tasks. In chronic and/or untreated cases, the muscles may weaken causing a loss in strength and grip.
Carpal tunnel syndrome is the result of pressure on the median nerve and tendons in the carpal tunnel. Many factors could contribute to the development of carpal tunnel syndrome:
- Heredity is the leading cause; carpal tunnels are smaller in some people than in others
- Overuse or injury to the hand and/or wrist that causes swelling
- Hormonal changes related to pregnancy
- Medical conditions, including diabetes, rheumatoid arthritis, and thyroid gland imbalance
Early diagnosis and treatment of carpal tunnel syndrome are important to avoid permanent damage to the median nerve. The doctor will conduct a physical examination that includes the following:
- Checking for weakness in the muscles around the base of your thumb and hand.
- Examining the wrist for tenderness or swelling.
- Tapping or pressing the median nerve to test for numbness or tingling in your hands or fingers. A shock-like sensation may also be felt.
- Testing the sensation in your fingers.
- Conducting routine laboratory tests and X-rays that could reveal underlying medical issues.
Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. By placing electrodes on the hand and wrist and sending small electric shocks, your doctor can evaluate how the median nerve functions and determine if there is any damage.
By diagnosing carpal tunnel syndrome promptly, you can relieve your symptoms without surgery. It is likely your doctor will try simple non-invasive treatments prior to recommending surgery.
Bracing or splinting. A brace or splint worn at night keeps the wrist in a neutral position, rather than curled during sleep. This can prevent symptoms at night.
Medications. Anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, (Motrin, Advil) and naproxen (Aleve), can reduce pain and swelling.
Activity changes. Avoid hand use and activities that aggravate the symptoms. Apply ice to the hand or wrist, if it is swollen. Getting a massage could also provide relief.
Steroid injections. A corticosteroid injection will often provide temporary relief, but symptoms may come back.
In some cases, surgery is needed to make the symptoms go away completely. The decision whether to have surgery is based mostly on the extent of your symptoms. In some cases, surgery is necessary to avoid damage to the median nerve.
Open release surgery is the most common procedure used to correct carpal tunnel syndrome and is often done under local anesthesia on an outpatient basis. The surgery consists of making an incision in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel.
Endoscopic surgery can shorten recovery time and allow patients to resume normal activities sooner. The surgery consists of two small incisions (about ½ inch each) in the wrist and palm where the surgeon inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament.
Although most symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months.
Right after surgery, you should ice your hand and wrist, as well as elevate your hand to reduce swelling and prevent stiffness. You may continue to feel sore in the palm of your hand for several months after surgery and muscle weakness may last for up to 6 months. You should discuss with your doctor when you should return to work and what activities you may need to modify.
Patients attend physical therapy after surgery to practice exercises that restore wrist, hand, and grip strength. Following treatment and physical therapy, recurrence of carpal tunnel syndrome is rare and the majority of patients recover entirely.