Carpal Tunnel Syndrome

Almost everyone experiences occasional pain and stiffness in their hands or wrists, especially after using them for long periods. It’s also normal to have the feeling of pins and needles in your hands after holding them in the same position for a while, such as leaning your head on your hand while in a meeting.

However, if the pain, tingling, numbness, and weakness do not go away after a little while—or it gets worse over time—you may have a common condition called carpal tunnel syndrome. At EmergeOrtho—Triangle Region, we are leaders in the treatment of carpal tunnel syndrome, with a team of Hand and Wrist Specialists experienced in the most advanced techniques for managing this potentially debilitating condition.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome occurs when there is excess, continuous pressure on the median nerve. This nerve travels from the neck through the arm and into the hand. There are many reasons why pressure on the nerve can occur – fractures, swelling around the wrist tendons, and thickening of the tissues near the nerve are a few.

The medial nerve and the flexor tendons travel through a narrow area in the wrist known as the carpal tunnel. The tunnel is a small opening formed by small wrist bones (carpal bones) and a strong band of connective tissue called the transverse carpal ligament. Because the ligament tissue is so strong and the other sides of the tunnel are bone, there is little room for the tunnel to stretch or widen.

Because of this, when pressure from swelling, fractures, or thickening of the ligament occurs, there is no “give” in the tunnel. When the tissues or structures around it change, pressure builds and compresses the median nerve. This pressure prevents the nerve from transmitting the information properly, causing pain and tingling or a feeling of pins and needles in your hands.

Symptoms of Carpal Tunnel Syndrome

The most common symptoms of carpal tunnel syndrome are tingling, numbness, a burning sensation, and pain, usually in the thumb and first three fingers. Other signs of the condition include:

• Sudden, infrequent shock-like feelings that radiate through the thumb and index, middle, and ring fingers.
• Pain and tingling in the forearms that might radiate toward the shoulder.
• Hand weakness that makes it difficult to perform tasks that require fine motor skills, like writing or fastening buttons.
• Hand weakness that causes you to drop items frequently.
• Changes in your perception of where your hand is located (loss of proprioception).

For many people, the symptoms of carpal tunnel syndrome start gradually, and may even come and go sporadically for months or even years. However, over time, the symptoms worsen, occurring more frequently or lasting longer.

Carpal Tunnel and Sleep Disruption

It is common for people with carpal tunnel syndrome to report worsening or more uncomfortable symptoms at night. Sometimes, the discomfort is enough to disrupt sleep.

Nighttime symptoms are often a result of sleeping with the wrists bent. During the day, symptoms may only occur when the wrists are bent for prolonged periods, such as when driving long distances or holding a book.

What Causes Carpal Tunnel Syndrome?

The most common cause of carpal tunnel syndrome is overuse, followed by improper hand or wrist position for long periods. Carpal tunnel can occur among people who work long hours on computers, for example, since they often keep their wrists in the flexed position and perform repetitive movements, which can cause tendons to swell.

Other common factors that can contribute to carpal tunnel syndrome include:

• Pregnancy. Hormone changes cause swelling that puts pressure on the median nerve.
• Genetics. Some people, particularly those with a smaller bone structure, may have naturally smaller carpal tunnels, which reduce the amount of space for the flexor tendons and median nerve.
• Chronic conditions. Rheumatoid arthritis, thyroid gland imbalance, and diabetes are associated with carpal tunnel syndrome.
• Vibrations. People who regularly work with vibrating tools, such as construction workers who use drills, are at risk for carpal tunnel syndrome. Hobbies that require holding the wrists in a flexed position or repetitive motions, like knitting, can also contribute to the condition.

Diagnosis and Treatment of Carpal Tunnel Syndrome

When diagnosed early, carpal tunnel syndrome is easily manageable. You should make an appointment to see a specialist as soon as symptoms start to prevent them from worsening. At the very least, you need to seek treatment for carpal tunnel syndrome if:

• Symptoms do not improve with home relief measures.
• Symptoms interfere with your normal activities.
• Symptoms have caused you to lose function in your thumb or fingers, which is a sign of nerve damage.

How EmergeOrtho Specialists Diagnose Carpal Tunnel Syndrome

EmergeOrtho Hand and Wrist Specialists diagnose carpal tunnel syndrome using physical examinations and tests.

During the physical exam, the doctor will take your medical history and perform a series of tests to check for numbness, tingling, and sensitivity. They will also check for muscle weakness and atrophy (loss of muscle in the hand), as well as look for other signs of nerve damage.

Although it is possible to make a diagnosis based on the exam results, further tests may be necessary to evaluate the extent of the condition. These tests may include:

• X-rays to rule out other causes of your symptoms, including fractures.
• Magnetic resonance imaging (MRI) to check for tissue or nerve damage.
• Nerve function tests to measure nerve and electrical activity in the median nerve.
• Ultrasound to check the median nerve for compression.

The results of these tests will guide the approach to the treatment of carpal tunnel syndrome.

Treating Carpal Tunnel Syndrome

When caught early, carpal tunnel syndrome can be managed with conservative, noninvasive treatments as the first course of action. Your doctor may recommend:

• Bracing or wrist splinting to keep your wrist in a neutral position and reduce pressure on the nerve. Some patients only need to wear a brace at night if their symptoms worsen during those times.
• Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.
• Steroid injections to reduce inflammation. Some patients in the early stages of carpal tunnel may receive lasting if not permanent relief after receiving injections, while those in the later stages may only experience temporary relief.
• Activity modifications can prevent pressure on the nerve. Your doctor may recommend working with a physical or occupational therapist to learn new techniques and proper body mechanics.

If several months of noninvasive treatment for carpal tunnel syndrome do not alleviate symptoms, your doctor may recommend surgery. Surgery can provide long-term relief from the symptoms, as well as prevent permanent nerve damage.

Orthopedic surgeons perform carpal tunnel release surgery to alleviate the pressure on the nerve by cutting the transverse carpal ligament that forms the top of the tunnel. Typically, during an outpatient (same-day) procedure, the surgeon divides the ligament to make more space; as it heals, the ligament retains the extra length, preventing recurrence. The procedure is done via a small incision in the hand, or endoscopically, using a small camera and tiny instruments.

Carpal Tunnel Treatment at EmergeOrtho—Triangle Region

The Hand and Wrist Specialists at EmergeOrtho—Triangle Region are among the leading experts in treating carpal tunnel syndrome in North Carolina. They use advanced techniques, including minimally invasive carpal tunnel surgery methods, to provide long-term relief and recovery from this uncomfortable but common condition.

If you have symptoms of carpal tunnel syndrome, do not wait. Self-schedule an appointment with a specialist or call us at (919) 220-5255 with questions today.