Carpal Tunnel Syndrome

Carpal Tunnel Syndrome affects the carpal canal at the base of the palm so when you are leaning on your hands you are placing pressure directly on the carpal canal. The canal contains many tendons and the median nerve that are tightly packed together. If the tendons or nerves become enlarged they take up more room in the canal thereby increasing the pressure.  When the carpal tunnel pressure reaches a certain level it interferes with median nerve function and thereby produces symptoms of Carpal Tunnel Syndrome.  Also changes in the bones that contribute to the canal may result in a smaller canal and again cause the carpal tunnel pressure to increase resulting in symptoms of median nerve compression. Bending the wrist position away from neutral such as flexion, extension or towards the little finger also increases the carpal tunnel pressure.  When these wrist positions are maintained or repeated frequently the effect on carpal tunnel pressure again causes median nerve symptoms.

Carpal Tunnel Syndrome Symptoms

Symptoms of Carpal Tunnel Syndrome can include wrist pain, pins and needles sensations, loss of dexterity and loss of pinch strength. Pressure on the median nerve produces the pins and needles sensation or numbness primarily in the thumb, index and middle fingers. Symptoms may occur while sleeping or are present upon awakening as carpal tunnel pressure is increased when sleeping with the wrist in a non-neutral position.  Patients may report having to shake their hands in the morning to wake them up.  If swelling and irritation of the tendons in the canal is present there may be wrist pain during the day with pins and needles at night from median nerve compression. As symptoms progress there is loss of dexterity due to the inability to feel small objects precisely.  Weakness of pinch may be noticed.  Sometimes the fingers will feel swollen even though their appearance is normal.

Examination

Early in the development of carpal tunnel syndrome when symptoms are intermittent the examination may be normal.  But when symptoms are present everyday there is usually decreased sensation in the thumb, index and third fingers.  When the median nerve is tapped at the wrist an electric sensation travels into the hand, this is a positive Tinel sign. If the wrist is held for one minute in the flexed position and tingling is felt in the fingers supplied by the median nerve this is a positive Phalen sign.  There may be weakness in the muscles at the base of the thumb.  If chronic swelling of the tendons at the wrist has been present there may be decreased range of motion especially with extension of the wrist.  Nerve conduction studies are frequently used to confirm the presence of carpal tunnel syndrome.

Treatment of Carpal Tunnel Syndrome

Treatment of Carpal Tunnel Syndrome is sometimes determined by contributing medical issues. There are many medical conditions, for example diabetes mellitus, hypothyroidism or rheumatoid arthritis that may cause carpal tunnel syndrome by changing the size of the nerve, tendons or carpal canal.  If medical conditions are present they need to be treated. For the symptoms of carpal tunnel syndrome non-surgical but specialized treatment consists of using a nocturnal wrist splint in order to maintain a neutral wrist position and taking a non-steroidal anti-inflammatory medication to treat the inflammation and pain.  If there is swelling at the wrist topical cold therapy are helpful along with corrective taping. Tendon gliding exercises are useful to regain full range of motion of the tendons.  At this time no strengthening of the hand should be done as it will aggravate the carpal tunnel syndrome.  Strengthening may be started when symptoms have resolved.

At COEN Carpal Tunnel Syndrome is frequently associated with work-related ergonomic stressors such as tasks that require repetitive forceful awkward wrist movements or prolonged use of the keyboard/mouse.  These ergonomic stressors need to be identified and modified when possible.  Hobbies may be an ergonomic stressor for the wrist/hand area and must also be addressed. Usually the response to non surgical individualized management is successful unless carpal tunnel syndrome is too advanced before treatment and then surgery may be required such as endoscopic release of the carpal canal.    

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