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Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is a painful condition that is caused by compression of the median nerve at the wrist. The median nerve is a major nerve that travels through a tunnel in the wrist that is formed by a group of wrist bones and a strong ligament. Traveling through the tunnel with the median nerve are tendons that attach to the fingers. These tendons are covered by a synovial sheath which functions to reduce friction as the tendons move. This sheath may become inflamed and thickened which reduces the space available for the other structures and causes the median nerve to become compressed against the transverse ligament.
The syndrome may be caused by inflammation of the wrist tendons, chronic inflammatory conditions, traumatic wrist injuries, thyroid disease, pregnancy, and diabetes. Cervical (neck) problems and diabetic neuropathy may mimic the symptoms of carpal tunnel syndrome.
Symptoms may include wrist pain, numbness/tingling of the thumb, index, and middle finger, and in advanced cases, wasting/weakness in the muscles of the thumb. It is very common for the pain/numbness to awaken the patient at night, and the patient to feel the need to shake the hands until the symptoms improve. There may be difficulty with activities such as unscrewing a cap, twisting knobs or holding a glass or cup.
Initial evaluation will include examination and plain x-rays of the wrist and hand. Further evaluation of patients who do not respond to therapy may include nerve conduction studies and/or evaluation of the cervical spine and nerve roots.
Treatment may include anti-inflammatory medications, nighttime wrist splints, avoidance of aggravating activities, and workplace ergonomic modifications. Any aggravating factors such as poor control of other diseases (diabetes, rheumatoid arthritis) should be corrected. Patients who do not respond to these measures may be candidates for cortisone injection. Intricate hand or microscopic surgery may be recommended for patients who do not respond to any other treatment.
If you have been prescribed anti-inflammatory medications, please take the medication daily for maximum benefit. Continue the medication until you are able to do all of your regular activities without pain.
You may be given a handout of wrist range of motion and strengthening exercises. Since these exercises can be very helpful for recovery, they should be done 1-2 times daily.
PREVENTION
There are several things you can do to improve symptoms and prevent a recurrence once healed:
- Elevate your arm on a pillow when lying down.
- Avoid overuse of the effected hand.
- Avoid bending your wrists down for prolonged periods of time.
- Make sure your wrists are in a comfortable position for repetitive activities and avoid resting them on hard surfaces.
- Make sure that any other diseases you may have that are known to aggravate carpal tunnel syndrome are well controlled. You may need to see your regular medical doctor.
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