Carpal Tunnel Syndrome

Animation: Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Symptoms:

Carpal tunnel syndrome is a medical condition that causes the median nerve in the wrist to become compressed. The median nerve and several tendons (flexor tendons that allow us to flex our fingers and wrist) run from the forearm to the hand through a small space in the wrist called the carpal tunnel, bound by bones (carpal bones) and ligaments. The median nerve controls sensation on the palm side of the thumb, index finger, middle finger and half of the ring finger. The little finger is innervated by a different nerve. The muscles around the base of your thumb are also controlled by the median nerve.

Compression of the median nerve can lead to numbness, tingling and weakness in the wrist and hand. Carpal tunnel can create electric shock sensations in the thumb, index and middle finger. Pain can also travel up the arm toward the shoulder or between the elbow and the wrist as well.

Carpal tunnel symptoms are usually gradual and can occur at any time. Carpal tunnel patients may complain to their doctor of pain at night that may awaken them from sleep. As many people sleep with their wrists in the curled position, this can cause compression of the median nerve leading to night pain. Carpal tunnel symptoms can also occur during the day, especially when holding things in their hand (such as a phone, book, tools, or while driving) and can often be relieved by “shaking it out” or moving the hands. These carpal tunnel symptoms may gradually become constant over time and cause additional problems such as dropping things more frequently. In severe cases, the muscles at the base of the thumb appear less full as they become weaker. These symptoms lead many to seek carpal tunnel pain management.

Causes:

Pain is caused when there is pressure placed on the median nerve. This can be caused by swelling of the synovium (the tissues surrounding the tendons in the wrist) or anything that causes the carpal tunnel to become narrower, including:

  • Wrist injuries or breaks, which can create extra pressure on the median nerve, severely narrowing the space in the carpel tunnel
  • Bone spurs
  • Medical conditions such as diabetes, rheumatoid arthritis and thyroid hormone imbalance
  • Smoking, which can reduce blood flow to nerves
  • Obesity
  • Pregnancy
  • Hormone alterations, such those experienced during menopause

Carpal Tunnel Risk Factors:

If left untreated, carpal tunnel syndrome can damage the median nerve and the muscles it innervates. There are various factors that can play a role in getting carpal tunnel syndrome.

Women are more prone to carpal tunnel syndrome simply because their carpal tunnel is generally smaller than in men.  There also may be a hereditary component, as it can run in families.

Chronic illnesses, such as diabetes and alcoholism increase your risk of median nerve damage. Inflammatory conditions, such as rheumatoid arthritis or infections, can also cause inflammation in the carpal tunnel area causing pressure on the median nerve.

Pregnancy, obesity, menopause and thyroid conditions can increase pressure on your median nerves due to increased pressure from fluid retention. This increases your risk for carpal tunnel syndrome. Generally, carpal tunnel syndrome during pregnancy usually resolves after the baby is delivered.

Work factors may also play a role in median nerve irritation and damage. Examples include prolonged work on a computer with poor hand and wrist placement on the keyboard and mouse. Individuals who work frequently with vibrating tools or have repetitive flexing of the wrist during their work may also be at risk of getting carpal tunnel syndrome. It is hard to definitively say that these workplace factors can and will create median nerve injury, but taking precautions and being aware of preventative measures can be important in preventing injury.

Testing:

To diagnose whether you have carpal tunnel syndrome, your carpal tunnel clinic doctor will do a physical exam and inquire about your health and daily routine, as well as any recent activities that may have led to the pain in your wrist. Certain tests such as blood tests and nerve testing may be done by your carpal tunnel clinic doctor to see if your median nerve is working properly and to check for any health problems that may be contributing to your symptoms.

Carpal Tunnel Pain Management and Treatment Options:

If your symptoms are mild, you may be able to treat carpal tunnel syndrome at home. Try refraining from activities that cause numbness and pain and rest your wrist between activities. Ice your wrist for 10-15 minutes every hour or two. Wearing a wrist splint at night and if possible, during the day, will also help keep your wrist in a neutral position, taking pressure off your median nerve. More advanced symptoms may be relieved with a number of carpal tunnel pain management treatment options at an APM carpal tunnel clinic, which include:

  • Steroid Injection
  • Minimally Invasive Nerve Blocks
  • Percutaneous Ultrasound Guided Carpal Tunnel Release

At Advance Pain Management, our carpal tunnel clinic doctors value the importance of an interdisciplinary approach to carpal tunnel pain management. For those treatments not offered by APM, we are able to refer you to other carpal tunnel clinic doctors.



Last reviewed July 2013 by APM's Medical Executive Committee.