Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is caused by pressure on the median nerve as it goes through the carpal tunnel, a narrow passageway surrounded by bones and ligaments on the palm side of your wrist. The median nerve provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around your thumb. If the median nerve is compressed, the symptoms can include numbness, along with tingling and weakness in the hand and arm.  This video from the American Academy of Orthopaedic Surgeons shows the anatomy of the carpal tunnel.

What causes Carpal Tunnel Syndrome?

Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. Most cases of carpal tunnel syndrome are caused by a combination of factors. Studies show that women and older people are more likely to develop the condition.

Other risk factors for carpal tunnel syndrome include:

• Heredity.  The carpal tunnel may be smaller in some people or there may be anatomic differences that change the amount of space for the nerve—and these traits can run in families.
• Repetitive hand use. Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
• Hand and wrist position. Doing activities that involve extreme positions of the wrist for prolonged periods of time can increase pressure on the nerve.
• Pregnancy. Hormonal changes during pregnancy can cause fluid retention at the wrist.
• Health conditions. Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.

What does Carpal Tunnel Syndrome feel like?

Carpal tunnel syndrome symptoms usually start gradually and include:

• Tingling or numbness. You may notice tingling and numbness in your fingers or hand. Usually the thumb, index, middle or ring fingers are affected, but not your little finger. You might feel a sensation like an electric shock in these fingers. Click here to see a picture of the area commonly affected.
  The sensation may travel from your wrist up your arm. These symptoms often occur while holding a steering wheel, phone or newspaper, or may wake you from sleep.
  Many people “shake out” their hands to try to relieve their symptoms. The numb feeling may become constant over time.
• Weakness. You may experience clumsiness or weakness in your hand and drop objects. This may be due to the numbness in your hand.  It can also be due to weakness of the thumb’s pinching muscles which are controlled by the median nerve.
• Night-time symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken you from sleep. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.

How is Carpal Tunnel Syndrome diagnosed?

Carpal Tunnel Syndrome can be diagnosed during a physical examination by your physician or physiotherapist.  They will talk to you about your general health, medical history, and symptoms. They will also examine your hand and wrist by:

• Pressing down or tapping at the inside of your wrist to see if it causes any numbness or tingling in your fingers (Tinel sign).
• Bending and holding your wrist in a flexed position to test for numbness or tingling in your hands,
• Testing sensitivity in your fingertips and hands by lightly touching them with a special instrument when your eyes are closed,
• Checking for weakness in the muscles around the base of your thumb,
• Looking for atrophy in the muscles around the base of your thumb. In severe cases, these muscles may become visibly smaller.

Electrophysiological tests are used to measure how well your median nerve is working and help determine whether there is too much pressure on the nerve.

Can Carpal Tunnel Syndrome be treated?

Prevention is key:

There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on your hands and wrists by:

• Reducing your force and relaxing your grip. If your work involves a keyboard, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink.
• Taking short, frequent breaks. Gently stretch fingers and wrists periodically. Also, alternate tasks when possible. This is especially important if you use equipment that vibrates or that requires you to exert a great amount of force. Even a few minutes each hour can make a difference.
• Improving your ergonomics at work.  Avoid bending your wrist all the way up or down for prolonged periods of time. A relaxed middle position is best. Keep your keyboard at elbow height or slightly lower.  Make sure that your computer mouse is comfortable and doesn’t strain your wrist.
• Improving your posture. Incorrect posture rolls your shoulders forward, shortening your neck and shoulder muscles and compressing nerves in your neck. This can affect your wrists, fingers and hands, and can cause neck pain.
• Keeping your hands warm. You’re more likely to develop hand pain and stiffness if you work in a cold environment. If you can’t control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.

Treatment options:

If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved without surgery.  Nonsurgical treatments may include:

• • • • Bracing or splinting. Wearing a brace or splint at night prescribed by a physiotherapist or other health care provider will keep you from bending your wrist while you sleep. Keeping your wrist in a straight or neutral position reduces pressure on the nerve in the carpal tunnel. It may also help to wear a splint during the day when doing activities that aggravate your symptoms.
      • Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as ibuprofen and naproxen can help relieve pain and inflammation.
      • Activity changes. Symptoms often occur when your hand and wrist are in the same position for too long—particularly when your wrist is flexed or extended.  If your job or recreational activities aggravate your symptoms, changing or modifying these activities can help slow or stop progression of the disease. In some cases, this may involve making changes to your work site or work station.
      • Nerve gliding exercises.  Specific exercises may be recommended by your physiotherapist to help the median nerve move more freely within the carpal tunnel.
      • Steroid injections. Corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the carpal tunnel. Although these injections often relieve painful symptoms, their effect is sometimes only temporary. A cortisone injection may also be used by your doctor to help diagnose your carpal tunnel syndrome.

When would I need surgery for Carpal Tunnel Syndrome?

If nonsurgical treatment does not relieve your symptoms after a period of time, your doctor may recommend surgery. The decision whether to have surgery is based on how much pain and numbness you are having in your hand. In long-standing cases with constant numbness and wasting of your thumb muscles, surgery may be recommended to prevent irreversible damage.

Where can I get help?

If you live in Saskatchewan you can book an in-person or online assessment with Cathy who is a physiotherapist and also a certified hand therapist. To schedule your assessment you can call the clinic at 306-343-7776 or book online at www.north49therapy.com.