Carpal Tunnel

Causes of Hand Pain

Most cases of carpal tunnel syndrome have no specific cause, although any or all of the following may serve as contributing factors:

• Frequent, repetitive small movements with the hands such as gripping or pinching activities. Typing or using a keyboard are not high-risk activities unless performed in non-ergonomic wrist positions.
• Activities requiring extreme positioning (flexion or extension) of the wrist, such as activities performed by dental hygienists.
• Frequent, repetitive grasping movements with the hands, such as with sports and certain physical activities
• Joint or bone diseases such as arthritis
• Hormonal or metabolic changes from menopause, pregnancy or thyroid imbalance
• Changes in blood sugar levels
• Other conditions or injuries of the wrist, including strain, sprain, dislocation, break, or swelling and inflammation

Symptoms of Carpal Tunnel Syndrome

The following are the most common symptoms of carpal tunnel syndrome. However, each individual may experience symptoms differently. Symptoms may include:

• Difficulty making a fist or gripping objects with the hand(s)
• Pain or numbness in the hand(s)
• Burning or tingling in the fingers, especially the thumb and the index and middle fingers
• Swollen fingers
• Pain and/or numbness that is worse at night, interrupting sleep

Diagnosing Hand Problems

Your physician will discuss your medical history to find out about any illnesses, prior injuries or repetitive activities that may be causing your symptoms. You may have a diagnostic test, too, including:

• Nerve testing (electromyogram) and nerve conduction studies: These procedures are used to evaluate any loss of functioning in the median nerve.
• X-rays: Although carpal tunnel syndrome cannot be diagnosed through x-rays, they can be used to check for bone problems caused by past injuries, arthritis, tumors or fractures that could be contributing to your carpal tunnel symptoms
• MRI (magnetic resonance imaging): This imaging procedure can be used to detect swelling of the median nerve, narrowing of the carpal tunnel or blood circulation problems.

Symptoms of Carpal Tunnel Syndrome

The following are the most common symptoms of carpal tunnel syndrome. However, each individual may experience symptoms differently. Symptoms may include:

• Difficulty making a fist or gripping objects with the hand(s)
• Pain or numbness in the hand(s)
• Burning or tingling in the fingers, especially the thumb and the index and middle fingers
• Swollen fingers
• Pain and/or numbness that is worse at night, interrupting sleep

Diagnosing Causes of Hand Problems

Your physician will discuss your medical history to find out about any illnesses, prior injuries or repetitive activities that may be causing your symptoms. You may have a diagnostic test, too, including:

• Nerve testing (electromyogram) and nerve conduction studies: These procedures are used to evaluate any loss of functioning in the median nerve.
• X-rays: Although carpal tunnel syndrome cannot be diagnosed through x-rays, they can be used to check for bone problems caused by past injuries, arthritis, tumors or fractures that could be contributing to your carpal tunnel symptoms
• MRI (magnetic resonance imaging): This imaging procedure can be used to detect swelling of the median nerve, narrowing of the carpal tunnel or blood circulation problems.

Non-Surgical Care 

Carpal tunnel symptoms can often be treated on your own. If you start to have symptoms of carpal tunnel damage, follow these initial steps to avoid continuing damage to the median nerve:

• Stop activities that cause numbness and pain. Avoid repetitive or sustained heavy pinching and gripping activities. Rest your wrist longer between activities. Ice your wrist for 10 to 15 minutes, once or twice an hour.
• Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to relieve pain.
• Wear a wrist splint at night to keep your wrist in a neutral position. This takes pressure off the median nerve. Your wrist is in a neutral position when it is straight or only slightly bent. Holding a glass of water is an example of your wrist in a neutral position.
• Do exercises to keep your fingers and wrist from getting stiff, but don't continue doing this if you experience pain or numbness.
• Make sure your workspace is ergonomic and that you maintain good posture while doing repetitive activities such as typing.

Hand Surgery for Carpal Tunnel Syndrome

Carpal tunnel release surgery is used to reduce the pressure on the median nerve in the wrist. The surgeon will make an incision in the ligament that forms the top of the carpal tunnel, which will relieve pressure on the median nerve. Any other tissue that may be putting pressure on the median nerve can also be removed during surgery, making more room in the tunnel and relieving pressure on the nerve.

• Open carpal tunnel release surgery allows the doctor to see more of the inner tissues and requires a small incision in the palm and wrist.
• Endoscopic carpal tunnel release surgery can be done with small incisions in the wrist only or in the wrist and palm.

Your surgeon will discuss your surgical options depending on your individual condition