Carpal Tunnel Symptoms
Carpal tunnel is often described as burning, tingling, or itching numbness in the palm of your hand and thumb, or index and middle fingers.
Symptoms usually start gradually and progress into a constant:
- Tingling or numbness. Usually the thumb and index, middle or ring fingers are affected, but not your little finger. Sometimes there is a sensation like an electric shock in these fingers.The sensation may travel from your wrist up your arm. These symptoms often occur while holding a steering wheel, phone or newspaper. The sensation may wake you from sleep.Many people “shake out” their hands to try to relieve their symptoms. The numb feeling may become constant over time.
- Weakness. You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb's pinching muscles, which are also controlled by the median nerve.
What Causes Carpal Tunnel?
Carpal tunnel syndrome is caused by pressure on the median nerve.
The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).
Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis.
There is no single cause in many cases. It may be that a combination of risk factors contributes to the development of the condition.
Other health problems that may seem like carpal tunnel syndrome include:
- Ligament damage
- Neuropathy, a nerve problem
- Wrist injury, such as a fracture
- Cervical (C6-7) root compression in the neck
It’s not as common, but for some people, carpal tunnel syndrome is caused by other health issues, like:
- Amyloidosis, a disease where proteins collect in your organs
- Birth control pills
- Rheumatoid arthritis
- Thyroid problems
Diagnosing Carpal Tunnel
There are a number of factors when diagnosing carpal tunnel. They often include one or more of the following tests:
- History of symptoms. Your doctor will review the pattern of your symptoms. For example, because the median nerve doesn't provide sensation to your little finger, symptoms in that finger may indicate a problem other than carpal tunnel syndrome.
- Physical examination. Your doctor will conduct a physical examination. He or she will test the feeling in your fingers and the strength of the muscles in your hand. Bending the wrist, tapping on the nerve or simply pressing on the nerve can trigger symptoms in many people.
- X-ray. Some doctors recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture.
- Electromyogram. This test measures the tiny electrical discharges produced in muscles. During this test, your doctor inserts a thin-needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. This test can identify muscle damage and also may rule out other conditions.
- Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose your condition and rule out other conditions.
Carpal Tunnel Treatment
Treating carpal tunnel as early as possible is the most important factor in resolving this problem.
A few things to consider include:
- Take more frequent breaks to rest your hands.
- Avoiding activities that worsen symptoms and applying cold packs to reduce swelling also may help.
- Try using a wrist splint
If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome, including:
- Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Nighttime splinting may be a good option if you're pregnant.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.There isn't evidence, however, that these drugs improve carpal tunnel syndrome.
- Corticosteroids. Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve pain. Sometimes your doctor uses an ultrasound to guide these injections.Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren't considered as effective as corticosteroid injections for treating carpal tunnel syndrome.
If carpal tunnel syndrome is caused by rheumatoid arthritis or another inflammatory arthritis, then treating the arthritis may reduce symptoms of carpal tunnel syndrome. However, this is unproved.
If your carpal tunnel doesn't improve using non-surgical techniques, then you can consider surgery.
Surgery may be appropriate if your symptoms are severe or don't respond to other treatments.
The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.
The surgery may be performed with two different techniques:
- Endoscopic surgery. Your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in your hand or wrist.Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.
- Open surgery. Your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.
Discuss the risks and benefits of each technique with your surgeon before surgery. Surgery risks may include:
- Incomplete release of the ligament
- Wound infections
- Scar formation
- Nerve or vascular injuries
During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve. This internal healing process typically takes several months, but the skin heals in a few weeks.