It begins with an aching and weakness in the hands and wrists, progressing to pain, tingling, and numbness. Before you know it, you have trouble performing simple tasks, typing, lifting heavier objects, and other chores requiring manual dexterity. When you wake up in the morning, your hand often feels tingly and numb; it takes a while to “shake out” the prickly sensation. If you have experienced these symptoms, you may be suffering from Carpal Tunnel Syndrome. Understanding the disorder, its symptoms, causes, and treatment can be the first step to finding relief from this debilitating condition.
There are certain other conditions that can cause Carpal Tunnel Syndrome, including hypothyroidism (underactive thyroid), arthritis, and diabetes. However, one of the most common triggers can be repetitive use of the hands, as with office work (typing or data entry), assembly work, mechanics, carpentry, and other jobs requiring continual hand movements repeated over time. Sometimes it can be an injury to the hand or wrist or a congenital malformation or weakness in the hand.
Whatever the cause, the basic anatomical process that causes the pain and numbness is a narrowing of the carpal tunnel, a small space through which the median nerve and other tendons pass from the forearm to the hand. Pressure on this nerve causes the pain and numbness experienced by sufferers. Since the median nerve controls sensation in the thumb and first three fingers, that is where the pain is felt, though sensation remains normal in the little finger.
As with many medical conditions, physicians advise that their patients refrain from smoking and follow a healthy diet, including at least moderate exercise. If discomfort presents, simply resting the hands and wrists and taking a break can be enough to restore hand function. It’s important to lift objects with the whole hand, not just the fingers, and to type with the hands higher than the wrists. It is also a good idea to use ergonomic office furniture and components when typing or performing data entry tasks. Ergonomic desk chairs are scientifically designed to provide proper positioning and support, with articulating headrests and adjustable arms. In addition, the use of a keyboard wrist rest will help keep wrists in a neutral position and the cushioning gel filling gently conforms to the shape of the hand and wrist. Often, simply following these suggestions can relieve the discomfort; however, if the problems persist, it may be necessary to consult a physician and seek treatment.
There are several forms of treatment that can resolve minor discomfort, or postpone more pronounced pain until such time as surgery is feasible.
- Wrist splints – This is a cloth-covered, elastic apparatus with a rigid core and Velcro-covered straps that hold the hand in an upright position. The splint can be worn at night, and if practicable, during the day.
- Medication – Non-steroidal anti-inflammatory drugs (NSAIDs) can generally offer relief from pain. These are generally over-the-counter medicines such as Ibuprofen-based products like Motrin and Advil.
- Corticosteroids – The doctor may recommend corticosteroid injections to relieve the swelling and inflammation.
Any of these solutions can help ease the symptoms of Carpal Tunnel Syndrome, however, if pain and numbness become chronic, surgery may be the only answer to resolving the condition.
As with most surgery, doctors don’t want to promote this as a solution until all other remedies have been exhausted. If the surgery occurs to soon, i.e. when the patient is relatively young, the surgery may only afford a temporary fix, with the condition reoccurring again years later. The objective of carpal tunnel surgery is to cut the ligament pressing on the median nerve. If your doctor determines that surgery is indicated, there are two alternatives to consider:
- Endoscopic Surgery – This surgery uses modern technology to view inside the carpal tunnel. An endoscope (small camera) attached to a telescopic device is inserted into a small incision to see inside the carpal tunnel and cut the ligament. This method causes less pain and inconvenience.
- Open Surgery – An incision is made into the hand over the carpal tunnel, cutting through the ligament to release the nerve. This procedure can be a bit more invasive than endoscopic surgery, and the incision can be somewhat larger.
It is important to discuss the matter with your physician to decide which method works best for you. Both have their advantages, and each case is specific to the individual.
After surgery, patients will slowly return to using their hands as the tissues grow back together and the enlarged space provides more room for the median nerve and tendons without impingement. There will be some temporary discomfort and weakness, but eventually, barring any complications (scar tissue, nerve damage, infection), full range of motion and mobility should be restored.
WebMD, “Carpal Tunnel Syndrome, Oct. 2, 2012, http://www.webmd.com/pain-management/carpal-tunnel/carpal-tunnel-syndrome-topic-overview
The Mayo Clinic, “Carpal Tunnel Syndrome,” Apr. 2, 2014, http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/definition/con-20030332