Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Evidence suggests that an estimated three percent of women and two percent of men will be diagnosed with carpal tunnel syndrome during their lifetime, with women over 55 the most affected. Carpal tunnel syndrome is a condition that can cause pain and dysfunction in the hand, wrist and forearm. It is caused by excessive pressure on one of the nerves in the wrist. The carpal tunnel is a narrow passageway (found within the center of the wrist) that encases and protects the nerve and tendons in the hand. The primary nerve, the median nerve, controls movement in the thumb and sensation in most of the hand. It is bound by the carpal tunnel ligament at its "roof," the carpal bones at its "floor" and is surrounded by the tendons that move digits. These structures can become thickened and constrictive for various reasons, including medical conditions, trauma and certain types of activities. This leads to a decrease in the space within the carpal tunnel and puts pressure on the median nerve. When under pressure, the nerve can cause pain, numbness, tingling, weakness and in some cases, permanent damage affecting the hand and fingers.

What are the symptoms of carpal tunnel syndrome?

Symptoms of carpal tunnel syndrome can include:

  • Numbness /tingling in the hand, particularly the thumb, index, and middle fingers
  • Pain in the wrist or hand, sometimes extending into the arm towards the shoulder
  • Weakness and clumsiness, problems with grip and pinch, dropping things
  • Symptoms are commonly worse at night or with certain activities like driving, holding objects, or forceful and repeated gripping

What causes carpal tunnel syndrome?

Carpal tunnel syndrome occurs when excessive pressure develops in the carpal tunnel, causing problems with the median nerve. In most cases, the exact cause is unknown. Genetic and anatomical factors may predispose people to for the condition. Excess pressure on the median nerve can be generated by thickening of the tendons (tenosynovitis), fractures, dislocations, arthritis and even forceful or excessive motion across the wrist.

Who is most likely to get carpal tunnel syndrome?

While the exact cause of carpal tunnel syndrome is unknown, there are known factors that contribute to it. For example, it is more common in women, possibly relating to hormonal influences. Other factors that contribute include:

  • Traumatic conditions decreasing the carpal tunnel space
    • Wrist fractures
    • Wrist dislocations
  • Inflammatory conditions
    • Rheumatoid arthritis
    • Gout
    • Lupus
  • Diabetes
  • Thyroid disease
  • Alcohol abuse
  • Tobacco use
  • Increased body mass index/obesity
  • Certain types of frequent/forceful use of hands
    • Packing/assembly/line work
    • Construction/mechanical labor

How is carpal tunnel syndrome diagnosed?

There are conditions that may present with symptoms similar to carpal tunnel syndrome, so it is important to be evaluated by an experienced hand and wrist specialist. The MOR Hand, Wrist & Elbow Institute physicians will carefully review a patient's medical history, symptoms, lifestyle and daily work habits. In addition, a careful exam of the hand, wrist and arm is performed to help rule out other conditions and determine the extent of disease and disability.

A physician may recommend some of the following studies:

  • X-rays
  • MRI scan
  • Nerve conduction studies
    • Measures how fast electrical impulses travel through the nerve
  • Electromyogram
    • Measures the electric activity of muscles at rest and when activated

What is the treatment for carpal tunnel syndrome?

If left untreated, carpal tunnel syndrome can lead to permanent problems with the nerve. This can result in a loss of sensation in the fingers and weakness, and atrophy of the hand. A careful evaluation, followed by appropriate treatment by physicians at Midwest Orthopaedics at Rush Hand, Wrist & Elbow Institute, can limit permanent losses and restore function and comfort. There are both surgical and non-surgical modes of treatment available as appropriate.

Non-surgical treatment options include:

  • Lifestyle and Occupational modifications
  • Splinting
  • Medication
    • Non-steroidal anti-inflammatories
    • Steroids
  • Therapy
  • Cortisone injection

When is surgery recommended?

If non-surgical modes of treatment fail or are no longer desired, surgery may be necessary. The goal of surgery is to increase the available space for the tendons and nerve within the carpal tunnel. This surgery, known as "carpal tunnel release," can be performed with minimally invasive techniques. Our preferred technique is the "mini-open" incision. This combines the safety and efficacy of the open technique while minimizing trauma and scarring. This decreases the risk associated with arthroscopic release and allows for more rapid recovery. The procedure is typically performed under a "local" anesthetic with the patient completely comfortable and awake. Typical operative time is 10 to 15 minutes. The technique incorporates a small incision in the mid-palm. The carpal tunnel ligament (transverse carpal ligament) is released, which alleviates the pressure on the nerve. As the ligament heals, the area of the carpal tunnel will be larger, leaving more space and less pressure on the tendons and nerve.