People go weeks, months, and even years ignoring tingling and numbness in their hands, blaming it on too much time spent typing. It isn’t until sharp pain accompanies the tingling and numbness that people bother to seek medical attention for their symptoms. The cause is almost always carpal tunnel.
The carpal tunnel is a narrow passage of bones and ligament at the base of your hand. When irritation and swelling makes the passage even narrower it can compress the median nerve that runs from your forearm to your hand. The compression of this nerve causes the symptoms that are known as carpal tunnel syndrome.
What does carpal tunnel syndrome feel like?
Carpal tunnel syndrome symptoms can range from very mild to severe and for most start gradually. At first the symptoms can include tingling, itching or numbness in the palms and fingers. Many people feel the symptoms at night. This is because we tend to sleep with our wrists flexed. As the symptoms worsen, they will be felt during the day as well as at night and can even make it difficult to grip small objects because of decreased strength in the hands. Pains that shoot up the arm between the hands and elbows can be intense and wake you up at night.
What causes carpal tunnel syndrome?
There is rarely just one cause of carpal tunnel syndrome. For most it is caused by a combination of things that add increased pressure on the median nerve. Some people just have a narrower tunnel than others. Injury and trauma to the wrist that leads to swelling is a common cause of carpal tunnel syndrome. Other possible causes include:
- an overactive pituitary gland
- rheumatoid arthritis
- fluid retention related to pregnancy or menopause
- issues with the wrist joint
- work-related stress
- diabetes and other conditions that can affect the nerves
How is it diagnosed?
Diagnosing carpal tunnel syndrome begins with the patient’s symptoms and an examination of the hands and arms as well as the neck and shoulders to rule out other issues that may cause symptoms that are similar to those of carpal tunnel syndrome. There are a couple of ways that a doctor can specifically test for carpal tunnel syndrome: The Tinel test and the Phalen test. They are performed as follows:
Tinel: The doctor presses and taps on the median nerve in your wrist. Feel a tingling or shock-like sensation indicates a positive result.
Phalen: This test involves flexing the wrists by holding your arms up while your hands face downward and are pressed back-to-back. If tingling or numbness is felt within 60 seconds then you likely have carpal tunnel syndrome. Your doctor may also use special tests such as electromyography or a nerve conduction study to confirm the diagnosis. Ultrasound may also be used.
What treatments are available for carpal tunnel syndrome?
There are a few different ways to treat carpal tunnel syndrome, your doctor will likely ask you to first rest your hand and wrist for approximately 2 weeks. This requires avoiding any activities or movements that can worsen your symptoms and wearing a splint to immobilize your wrist.
Surgery is an option in severe cases, but should be looked at as a last resort. Non-surgical treatment options include:
- NSAIDs, such as ibuprofen and aspirin can help relieve pain and inflammation.
- Wearing a wrist splint to help keep your wrist straight.
- Corticosteroids, either oral or injections, can offer immediate relief of symptoms by relieving pressure on the median nerve.
- Physical therapy and exercise, such as special stretches and strengthening exercises, and yoga.
- Alternative therapies like chiropractic and acupuncture may offer relief of symptoms.
What does carpal tunnel surgery entail?
The goal of carpal tunnel surgery is to release the pressure on the median nerve. This is done by cutting the ligament that makes up the top of the tunnel and is located on the palm side of your hand. Cutting the ligament instantly creates more space which decreases the pressure on the median nerve and offers relief of symptoms that happens immediately for some and over weeks or months for others. In some cases surgery doesn’t alleviate all of the symptoms. It is common to feel some pain and discomfort in the area around the incision for a few weeks after the surgery while it heals.