Carpal tunnel syndrome

Carpal tunnel syndrome

Hand and Wrist ​Condition

Carpal tunnel syndrome

Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm.  Although it is often associated with repetitive hand movements, such as typing, carpal tunnel syndrome can be caused by many things.

Anatomy

The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and sides of the tunnel are formed by small wrist bones called carpal bones. The roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament.

Causes

Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when tissues surrounding the flexor tendons swell, putting pressure on the median nerve. These tissues are called the synovium. Normally, the synovium lubricates the tendons, making it easier to move your fingers.

When the synovium swells, it takes up space in the carpal tunnel and, over time, crowds the nerve.

Risk Factors

Other risk factors for carpal tunnel syndrome include:

  • This is likely an important factor. 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.
  • Hormonal changes during pregnancy can cause swelling.
  • Health conditions including diabetes, rheumatoid arthritis and thyroid gland imbalance.

 
Most cases of carpal tunnel syndrome are caused by a combination of factors.

Symptoms

Symptoms of carpal tunnel syndrome may include:

  • Numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers
  • Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
  • Pain or tingling that may travel up the forearm toward the shoulder
Treatment

Although it is a gradual process, for most people carpal tunnel syndrome will worsen over time without some form of treatment. For this reason, it is important to be evaluated and diagnosed by your doctor early on. In the early stages, it may be possible to slow or stop the progression of the disease.

Non-surgical treatment

If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved without surgery with some of the following methods:

  • Bracing or splinting.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Activity changes.
  • Steroid injections.
Surgical treatment

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 the severity of your symptoms—how much pain and numbness you are having in your hand.

In most cases, carpal tunnel surgery is done on an outpatient basis under local anesthesia.

During surgery a small incision is made in the palm of your hand. The roff (transverse carpal ligament) of the carpal tunnel is divided. This increases the size of the tunnel and decreases pressure on the median nerve. After surgery, the ligament may gradually grow back together—but there will be more space in the carpal tunnel and pressure on the median nerve will be relieved.

Endoscopic carpal tunnel release: Some surgeons make a smaller incision in the skin and use a small camera, called an endoscope, to cut the transverse carpal ligament from inside the carpal tunnel. This can speed up the recovery process.

The outcomes of open surgery and endoscopic surgery are similar. Your doctor will talk with you about which surgical technique is best for you.