Carpal Tunnel Syndrome

Carpal tunnel syndrome is one of the most common conditions hand specialists treat – it is a compressed nerve in the wrist. The median nerve controls sensation in the thumb, index and middle fingers as well as part of the ring finger. It can become compressed between the bones at the bottom of the wrist and the ligament on the top of the wrist. Carpal tunnel syndrome is a progressive condition. While there are several home remedies or over-the-counter treatments available, persistent and severe cases are typically treated with surgery.

Carpal Tunnel Symptoms

• Numbness in the thumb, index, middle and ring fingers
• Tingling in the thumb, index, middle and ring fingers
• Pain, numbness or tingling at night
• Difficulty holding or handling objects, such as a phone, steering wheel or computer mouse
• Wrist pain, occasionally

Carpal tunnel symptoms are mild at first and worsen over time. Eventually, in severe cases, the muscles at the base of the thumb become visibly weaker. If your symptoms are persistent, waking you up at night or are making it difficult to perform daily tasks, you should talk to your doctor. For many people, these symptoms come up during a yearly physical exam. Your doctor may refer you to a hand specialist, or you can schedule with a specialist directly.

What Causes Carpal Tunnel Syndrome

Most cases of carpal tunnel syndrome do not link back to a specific cause. The condition is often due to a combination of risk factors that can put pressure on the wrist and median nerve.

Risk factors that can trigger carpal tunnel syndrome include:

• Wrist injury or trauma, such as a fracture or dislocation, that results in swelling in the carpal tunnel area
• Inflammatory autoimmune conditions, such as rheumatoid arthritis, that result in joint inflammation
• Diabetes
• Hypertension (high blood pressure)
• Hypothyroidism (underactive thyroid gland)
• Pregnancy or hormone changes, which can lead to fluid retention and swelling
• Repetitive hand or wrist motion

Studies have shown that women are three times more likely than men to develop carpal tunnel syndrome. It can occur in adults of all ages.

Diagnosing Carpal Tunnel Syndrome

Orthopaedic hand specialists are experts in diagnosing and treating carpal tunnel syndrome. When you schedule a visit with a Froedtert & MCW orthopaedic hand specialist, the doctor will review your medical history and do a physical exam of your neck, arms, wrist and hands. The exam will check your thumb’s strength and range of motion.

There are also several simple tests to produce symptoms and determine if what you are feeling is in fact carpal tunnel syndrome. For example, the Tinel sign test involves tapping on the inside of the wrist, over the median nerve, to provoke a tingling sensation.

Your hand specialist may also recommend a visit with a physiatrist or a neurologist for an electromyography, or EMG, to confirm the diagnosis. An EMG for carpal tunnel involves the insertion of a thin needle or electrode into the muscles of the hand. As the muscles are stimulated and contract, their electrical activity is measured.

Carpal Tunnel Syndrome Treatment

Surgery is the most successful treatment for carpal tunnel syndrome. Nonsurgical methods are typically only effective if the condition is found early, before symptoms progress. Splinting the wrist, over-the-counter anti-inflammatory medications and physical or occupational therapy can help relieve mild symptoms. Occasionally, a cortisone injection in the wrist is given to people when the EMG shows no signs of nerve damage. If cortisone results in relief, it is a good indicator that surgery will be successful.

Surgery to Correct Carpal Tunnel Syndrome

When conservative treatment options fail, surgery is recommended and is highly successful. The carpal tunnel release procedure is one of the most common orthopaedic surgical procedures in the U.S. It is a minimally invasive procedure done with sedation and a local anesthetic and only takes about five minutes to perform. The orthopaedic surgeon makes a small incision on the wrist and releases the transverse carpal ligament. This enlarges the carpal tunnel and decreases pressure on the nerve.

You may feel some discomfort in the area for a day or two after the procedure. On day three, we recommend you see one of our occupational therapists who can help guide your recovery and help you regain strength. After two weeks, your doctor will remove stitches. Most people make a full recovery in about four weeks.