One of the more common conditions that causes pain in the hands and wrists is carpal tunnel syndrome. The origin of the disorder is still somewhat unknown but certain movements in the hands and wrist can aggravate the condition and lead to sharp or dull pain, stiffness and weakness in the hand and wrist. This is especially true for repetitive movements or performing a motion for extended periods of time, such as typing or sowing.
If you think you may be suffering from carpal tunnel syndrome, schedule an appointment with a hand and wrist specialist at Banner Health.
Carpal tunnel syndrome is stress or compression to the median nerve, which runs through the palm side of the hand. The median nerve provides sensation (feel) to the thumb, index finger, middle finger and part of the ring finger. Swelling constricts the space around the nerve and causes the compression of this nerve. This can lead to numbness, weakness and tingling on the side of the hand near the thumb.
While the root cause is still up for debate, it is certain that inflammation is what causes nerve compression. A common cause of this inflammation is an underlying medical condition that causes swelling in the wrist and a restriction of blood flow. Conditions that are frequently linked to carpal tunnel syndrome include:
The symptoms of carpal tunnel syndrome may be worsened by overuse of the hands or wrists. Repetitive motions can aggravate swelling and compression on the median nerve. Aggravating motions can include:
Symptoms of carpal tunnel syndrome usually start gradually and worsen over time or with aggravation. Common symptoms include:
Tingling or numbness – This can be in the fingers or hand, usually in the thumb, index, middle and ring fingers, and can move to the wrist and lower arm. The sensation may also feel like a mild electric shock.
Pain in the joints – Pain can accompany tingling, usually in the finger joints and can move all the way up to the shoulder.
Weakness – This can affect your grip strength or ability to pinch small objects and can be more severe in older adults.
More severe cases may cause muscle atrophy or wearing away at the base of the thumb and a loss in the ability to tell hot from cold.
Diagnosis of carpal tunnel syndrome can be done with a combination of your medical history, a comprehensive physical examination and a test called a nerve conduction study. During a physical examination, your doctor will be looking for any signs of tenderness, swelling or deformity.
The nerve conduction study is a test that measures the conduction speed or your nerve impulse. A slower impulse of the nerve as it passes into the hand could confirm a carpal tunnel syndrome diagnosis.
Treatment for carpal tunnel syndrome will be most effective if it is started as soon as possible after diagnosis. Early-stage treatment can include these simple steps:
Initial medical treatment often includes wrist splinting and medication to reduce pain or inflammation, such as NSAIDs (Nonsteroidal Anti-Inflammatory Drugs).
Your doctor may recommend corticosteroids, such as cortisone, to relieve pain and swelling. An ultrasound machine may be used in the process to help doctors guide the medication and ensure it reaches the affected area.
If symptoms are unresponsive to other treatments or if symptoms worsen, a surgical procedure may be the next step in treatment.
The goal of surgery is to relieve pressure on the median nerve. The procedure used to accomplish this is called carpal tunnel release surgery. In this procedure, surgeons cut through the carpal ligament to create more space for the median nerve and surrounding tendons. The procedure can be performed in two different ways:
Endoscopic Surgery – Performed using small incisions, a scope and a tube with a camera and a light. This allows for the surgery to be done with minimal invasiveness, less pain and shorter recovery time.
Open Surgery – For more severe or complicated cases, this procedure is done by making an incision to the palm of the hand over the carpal tunnel and cutting through the ligament to free the nerve from pressure.
Relief from pain may be immediate but complete healing can take weeks or even months. During the healing process, the ligament tissues are gradually growing together while allowing for more space for the nerve. The internal healing may take several months but the skin incision will heal within a few weeks.
You may experience pain, swelling and stiffness following the operation. Your doctor will recommend that you gradually begin using your hand and wrist after the ligament has healed, initially avoiding any heavy usage.