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Carpal Tunnel Syndrome

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Written by
Benjamin Schwartz, MD, FAAOS.
Orthopedic Surgeon, Sports Medicine North
Last updated March 15, 2021

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Knowing the symptoms of carpal tunnel syndrome can help you get it treated and prevent it from getting worse.

What is carpal tunnel syndrome?

Carpal Tunnel Syndrome (CTS) is a painful nerve condition of the hand or wrist area. It can cause pain, numbness, and weakness in the fingers.

Most cases of CTS do not have a clear cause. Repetitive motions from keyboard use or similar activity may be responsible.  Though this has not been proven.

Most common carpal tunnel symptoms

Pro Tip

Symptoms do not usually involve the whole hand. The small finger and half of the ring finger next to the small finger should not be affected. —Dr. Benjamin Schwartz

There are 3 main nerves in the wrist. CTS is caused by pressure on the median nerve. The median nerve runs through the thumb, index, middle, and one side of the ring finger.

When there is pressure on the median nerve, the fingers may become painful, numb, and tingly. It can affect one or both hands.

Symptoms often worsen at night.  It may interrupt your sleep. Or you may feel it when you wake up in the morning

Eventually, the muscles at the base of the thumb may shrink. It can become difficult to pinch. Or pick up small objects.

What are the warning signs of carpal tunnel syndrome?

  • Pain in the wrist and/or hand.
  • Numbness or tingling in the thumb, index, middle,  and one side of the ring finger.
  • Pain when doing repetitive hand/wrist motions.
  • Numbness or tingling when the wrist or hand is in extreme positions—bent far forward or backward.
  • Wrist or hand pain at night or first thing in the morning.
  • Loss of fine motor control (e.g. picking up small objects, buttoning, pinching).

Other Carpal Tunnel Symptoms

  • Pain radiating up the arm.
  • Shrinking of the muscles at the base of the thumb. You may notice it looks flattened or indented.

What causes carpal tunnel syndrome?

Dr. Rx

It’s a misconception that there’s a direct link between typing/keyboard use and CTS. It has never been established.  However, poor wrist posture (with any type of activity) can contribute to symptoms. It is important to maintain good posture and take frequent breaks. —Dr. Schwartz

CTS is the most common nerve compression syndrome, but the exact cause is often unknown. (When a cause for an illness or condition is unknown it is called  idiopathic.) Still, there are some factors that make you more likely to develop it.

  • Diabetes.
  • Obesity.
  • Thyroid Disease.
  • Pregnancy.
  • Kidney Disease.
  • Inflammatory arthritis (e.g. rheumatoid arthritis).
  • Alcoholism.
  • More common as you get older.
  • Female gender. Women are 2 to 3 times more likely than men to have CTS.
  • Doing work that involves repetitive vibrations such as construction or machining.

Carpal tunnel risk factors

The carpal tunnel is a very narrow area of the wrist.  The median nerve runs through it. CTS is caused by the median nerve being compressed. Certain factors make it more likely to happen.

  • Repetitive hand/wrist activity.
  • Exposure to repetitive vibrations.
  • Sleeping with the hand and wrist in extreme positions (particularly bent).
  • Pre-existing medical conditions.
  • Genetic (inherited) factors.
  • Trauma to the hand and wrist—known  as “acute carpal tunnel syndrome.”

What will happen if carpal tunnel syndrome is not treated?

Pro Tip

Some patients with carpal tunnel-like symptoms may actually have a pinched nerve in their neck.  It is possible to have both CTS and a pinched nerve. The so-called double-crush phenomenon.  —Dr. Schwartz

Early symptoms of carpal tunnel syndrome do not usually require immediate medical attention.  You can wait to see if symptoms go away.

  • Stop or at least modify any repetitive activity involving the hand.
  • Take anti-inflammatories (NSAIDS) such as ibuprofen (Motrin, Advil) or naproxen (Aleve).
  • Wear a wrist splint.  It relieves some of the pressure on the nerve.

When to call your doctor.

  • After 4 to 6 weeks you have lingering or worsening numbness, constant pain, weakness, or loss of fine motor control.
  • Loss of strength or shrinking of the muscle at the base of the thumb.

Diagnosing carpal tunnel syndrome involves a physical examination. You may be asked to do specific movements to trigger symptoms.  In some instances, you may be given an electromyogram (EMG). It’s a nerve test that can confirm CTS.

Carpal tunnel treatments

Early cases are usually treated without surgery. More advanced cases may require surgery. If you are night splinting or getting cortisone injections,  follow up with your doctor after 4 to 6 weeks. If there’s no noticeable improvement, your doctor may want to discuss surgery as an option.

You may need to see an orthopedic or plastic surgeon with special training and certification in Hand and Upper Extremity Surgery.

Some typical ways to treat.

  • Avoid triggering activities. Reduce repetitive wrist motions or regular exposure to vibrations. Also avoid extreme bending of the wrist.
  • Brace or splint are typically worn at night. They keep your wrist stable. It may also help. They  may help with symptoms too.

It can be bought at a drugstore or ordered online. Some doctor’s offices may keep on hand.

  • Occupational Therapy for CTS may include exercises to stretch the wrist. As well as ultrasound, hot wax treatment, and iontophoresis (electrical current).  Often, you’ll first need a referral from your doctor.
  • Anti-inflammatories (NSAIDS). Over-the-counter medications such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can relieve symptoms. Prescription NSAIDs may be prescribed when OTC medications aren’t effective.

The key to success for NSAIDs is to take them on a regular schedule for at least 2 to 3 weeks. People often stop taking them too soon.

  • Cortisone shots relieve pain for around  80% of patients for up to 6 weeks.  However, only 20% are symptom-free a year later.
  • Surgery may be suggested if other treatments are not helping. It is known as carpal tunnel release surgery. The surgeon cuts the ligament that is pressing down on the median nerve.

Injections and surgery for carpal tunnel syndrome

Cortisone injections for CTS  can be done at your primary care or surgeon’s office.  After numbing the skin, a small needle is used to inject cortisone into the wrist. Symptom relief usually occurs within a few days and on average lasts 4 to 6 weeks.

Carpal tunnel release surgery is one of the most common orthopedic procedures.

After surgery, you will see your doctor in 1 to 2 weeks to remove stitches. Symptoms will gradually go away as you heal.  Depending on what you do for a living, you can expect to resume everyday job duties in 1 to 6 weeks.

You can expect pinch strength to return within 6 weeks. Grip strength in 3 months.  Scar pain can last 3 to 4 months.

Though, sometimes, issues linger, depending on factors like your age and the severity and duration of symptoms. For instance, you may not regain total grip strength.

Prevention

Do your best to avoid repetitive wrist and hand motions. And extreme wrist positions, like bending it back and forward. Also take frequent breaks.

If you've recovered from CTS, splinting, particularly at night, may keep symptoms from returning.

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Orthopedic Surgeon, Sports Medicine North

Dr. Schwartz is a board-certified Orthopedic Surgeon and Member of the Buoy Medical Advisory Board. He graduated Magna Cum Laude from the College of William and Mary (1998) with a B.S. in Biology, then obtained his medical degree from the Medical College of Virginia (2002) where he was elected to the Alpha Omega Alpha Medical Honor Society. After completing his Orthopedic Surgery Residency at Boston Medical Center (2007), Dr. Schwartz performed a fellowship in Adult Reconstruction at the Anderson Orthopedic Clinic in Alexandria, VA (2008). As a private practice surgeon, Dr. Schwartz specializes in the treatment of hip and knee arthritis including joint replacement surgery.

On a national level Dr. Schwartz serves several leadership positions including as an Editorial Board Member of the Journal of Arthroplasty, a member of the Practice Management Committee of the American Association of Hip and Knee Surgeons, and a member of the Hip and Knee Content Committee for the American Academy of Orthopedic Surgeons. With a keen interest in healthcare technology, Dr. Schwartz has served as a mentor for several digital health incubators and as an advisor for health tech startups. He joined Buoy as a content writer in 2019 and became a member of the Medical Advisory Board in 2020.

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