Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is essentially a pinched nerve in the wrist. There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the nerve.

What causes it?

Pressure on the nerve can happen several ways, including:

• Swelling of the lining of the flexor tendons, called tenosynovitis
• Joint dislocations
• Fractures
• Arthritis
• Fluid retention during pregnancy

The situations listed above can narrow the carpal tunnel or cause swelling in the tunnel. Thyroid conditions, rheumatoid arthritis and diabetes can also be associated with carpal tunnel syndrome. Ultimately, there can be many causes of this condition.

Signs and symptoms

Some of the symptoms of carpal tunnel syndrome may include:

• Numbness and tingling that is often worse at night
• Waking up at night, having to shake hand or hold over the side of the bed
• Fingers feeling swollen or fuzzy
• Dropping objects
• Weak pinch
• Discomfort in wrist, hand or fingers

Treatment

Dr. Daniel Singer performs a carpal tunnel injection.

Symptoms may often be relieved without surgery. Identifying and treating medical conditions, changing the patterns of hand use, or keeping the wrist splinted in a straight position may help reduce pressure on the nerve. Wearing wrist splints at night may relieve the symptoms that interfere with sleep. A steroid injection into the carpal tunnel may help relieve the symptoms by reducing swelling around the nerve.

When symptoms are severe or do not improve, surgery may be needed to make more room for the nerve. Pressure on the nerve is decreased by cutting the ligament that forms the roof (top) of the tunnel on the palm side of the hand. Incisions for this surgery may vary, but the goal is the same: to enlarge the tunnel and decrease pressure on the nerve. Following surgery, soreness around the incision may last for several weeks or months. The numbness and tingling may disappear quickly or slowly. It may take several months for strength in the hand and wrist to return to normal. Carpal tunnel symptoms may not completely go away after surgery, especially in severe cases.