Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a condition in which the median nerve is compressed as it passes through an opening from the wrist to the hand called the carpal tunnel. The carpal tunnel is about 1½ inches long and is located at the base of the hand near the wrist. It is bordered on three sides by the carpal bones and on the palm side by a tight band of connective tissue called the transverse carpal ligament. The median nerve provides sensory and motor functions to the thumb and three middle fingers. While CTS can be painful, its essential symptom is numbness or tingling in the thumb, index finger, long and part of the ring finger.

According to the National Institute of Neurological Disorders and Stroke, carpal tunnel release is one of the most common surgical procedures performed in the U.S. Carpal tunnel syndrome is three times more common in women than men. It usually only occurs in adults.

Hand Pain: Causes and Risk Factors 

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
• Difficulty gripping objects with the hand(s)
• Pain and/or numbness in the hand(s)
• "Pins and needles" feeling in the fingers
• Swollen fingers
• Burning or tingling in the fingers, especially the thumb and the index and middle 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. Additional diagnostic tests can include:

• 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.

UC San Diego Health treats all types of hand conditions.

Treating Hand Pain Non-Surgically

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 pain or numbness result.
• Make sure your work space is ergonomic and that you maintain good posture while doing repetitive activities such as typing.
  

If self-care does not resolve symptoms, there are other non-surgical treatment options, including getting a steroid injection and hand therapy. UC San Diego Health has certified hand therapists who can help you.

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 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. After surgery, formal physical therapy is usually not necessary and is prescribed on a case-by-case basis. Patients often do well with their own home exercise program.