Say the words “carpal tunnel syndrome” and most people think of wrist pain resulting from too much time spent at a computer keyboard. But this is incorrect, writes Jeffrey M. Jacobson, MD, a Hand, Wrist and Peripheral Nerve Surgery specialist with Westchester Health Orthopedics and Sports Medicine, in his recent blog.
Multiple studies examining the connection between excessive computer use and carpal tunnel syndrome have not found enough evidence to support a link. In fact, although a number of factors have been associated with carpal tunnel syndrome, including anatomy (smaller carpal tunnel), gender (more common in women), nerve damaging conditions, inflammation and thyroid disorders, none of these factors has been established as a direct cause of carpal tunnel syndrome.
What is carpal tunnel syndrome?
The carpal tunnel is a narrow passageway located inside the palm side of the wrist that is made up of bones and a wide band called the transverse carpal ligament. This tunnel protects the median nerve — a major nerve running from the forearm into the palm of the hand that controls sensation to the palm side of the thumb and fingers (except the small finger). The median nerve also controls small muscles in the hand which allow the fingers and thumb to move.
Carpal tunnel syndrome results when swelling or thickening from irritated tendons and nerves, or other inflammation, narrows the tunnel and causes the median nerve to be compressed. (In effect, it is a pinched nerve at the wrist.)
Symptoms of carpal tunnel syndrome
Symptoms usually include:
- pain, tingling or numbness in the hand, wrist or forearm (can be in combination)
- numbness or pain in the fingers that causes waking at night (usually in the thumb, index, middle and ring fingers)
- decrease or loss of thumb function and hand dexterity
Patients with carpal tunnel syndrome typically complain of numbness or pain at night, which frequently wakes them from sleep. Symptoms also may be noticeable during daily activities such as driving or reading a newspaper. In addition, people with carpal tunnel syndrome may notice clumsiness with their hands and a tendency to drop things.
What causes carpal tunnel syndrome
Pressure on the median nerve can happen many ways (or a combination of ways):
- injury to the muscles, ligaments, tendons or bones
- nerve problems in the fingers, elbow or neck
- rheumatoid arthritis in the thumb joint or wrist
- joint dislocations or fractures
- keeping the wrist flexed for long periods of time
- fluid retention during pregnancy
- thyroid conditions
Nonsurgical therapy can help mild to moderate symptoms
Carpal tunnel syndrome should be treated as early as possible after symptoms begin. If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome. Methods may include: splinting the wrist in a slightly extended position, non-steroidal anti-inflammatory drugs or corticosteroids. Splinting and other conservative treatments are more likely to help someone with mild symptoms that have been present for less than six months.
Other non-surgical treatments include: identifying and treating medical conditions and changing the patterns of hand use.
For severe or persistent symptoms, surgery may be needed
If symptoms are severe or persist for more than six months, despite trying nonsurgical therapy, surgery may be the best option to free the ligament to allow more room for the median nerve in the carpal tunnel. Carpal tunnel release is one of the most common surgical procedures performed in the U.S.
To read Dr. Jacobson’s blog in its entirety, click here.