If your fingertips feel tingly or numb, you might have carpal tunnel syndrome (CTS). CTS is a condition in which the tendons in the wrist swell, putting pressure on a nerve and causing numbness in the hand and fingers. The numbness and tingling can sometimes become so intense that it is painful. It can be caused by hereditary factors, repetitive strain, and trauma, and can make daily activities like typing and writing difficult.
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What Is Carpal Tunnel Syndrome?
One of the important nerves in your arm is called the median nerve. It travels from your neck to your fingertips.
This nerve helps you feel things with the tips of your thumb, index, middle, and part of your ring finger. It also helps you make specific thumb movements. The nerve travels through a tunnel in your wrist made by wrist bones – the carpal tunnel.
The carpal tunnel contains wrist bones and a ligament (transverse carpal ligament) across the wrist where the palm and forearm meet. Tendons and the median nerve pass through this space to your hand. The median nerve supplies feeling and some movement to part of your hand.
CST happens when the tendons in the wrist start swelling and put pressure on the nerve, which causes numbness in the hand and fingers.
What causes carpal tunnel syndrome?
According to the American Academy of Orthopaedic Surgery, there is no single cause of CST. However, it is usually caused when a health condition or problem makes the carpal tunnel space too small. This puts pressure on the median nerve and causes pain, tingling, and other symptoms. If you are born with a narrower tunnel, you have a higher chance of experiencing CTS.
How common is carpal tunnel syndrome?
Problems in the median nerve are present in about a third of people by age 65, although levels of symptoms vary.
Carpal tunnel syndrome risk factors
Risk factors for carpal tunnel issues include:
- Age — It's more common in adults, and repeated hand use with age and time can worsen the condition.
- Gender — Women are more likely than men to get this syndrome
- Genetics — Certain families and traits are more vulnerable to developing CST.
- Medical history — Other health issues, such as arthritis, can increase your risk.
- Pregnancy — Pregnant people may get it, but it often goes away after giving birth.
Along with these predisposing factors, other issues that can cause carpal tunnel syndrome include:
- Hormonal levels.
- Circulation problems.
- Nerve damage.
Complications of carpal tunnel syndrome
Without proper treatment, carpal tunnel syndrome can make daily activities very tough, such as:
- Buttoning clothing.
- Holding everyday items like a coffee cup.
- Typing.
- Writing.
It can lead to a feeling of clumsiness. As the syndrome intensifies, there may be some visual deformities around the wrist tendons.
What Are the Symptoms of Carpal Tunnel Syndrome?
Carpal tunnel syndrome often produces symptoms gradually or during specific activities, like typing or working. Over time, symptoms can present more frequently and for longer periods.
The most common carpal tunnel syndrome symptoms include:
- Intense pain and discomfort in the thumb and three main fingers.
- Loss of feeling in fingertips.
- Numbness or stabbing to the thumb side of the hand that occurs gradually and worsens over time.
- Shooting pains in the arms.
- Tingling feelings throughout the wrist, hands, and fingers — especially at night.
At the beginning stages of carpal tunnel syndrome, shaking out the wrists may temporarily help relieve symptoms.
As it progresses, you may need further treatment to manage your carpal tunnel pain and symptoms.
When should I see a doctor for my carpal tunnel symptoms?
If your symptoms only bother you at night, you can try wearing a splint to keep your wrist straight. If your hand goes numb regularly, even with the splint on, it takes a while for the numbness to go away, or the numbness becomes constant, surgery is recommended.
How Do You Diagnose Carpal Tunnel Syndrome?
Doctors diagnose carpal tunnel syndrome by looking at your medical history, asking you questions about your symptoms, and testing the:
- Ability to use the hand.
- Extent of numbness in the hand.
- Strength of the thumb.
How do you test for carpal tunnel syndrome?
Your doctor may also want to run some diagnostic tests to formally diagnose CST.
Common tests include:
- Electrical testing to gauge nerve functioning.
- Nerve conduction tests to help identify the location and size of the nerve.
- Ultrasound to examine the nerve.
- X-rays to rule out bony deformities in the arms and wrists.
How Do You Treat Carpal Tunnel Syndrome?
Treatment for carpal tunnel primarily aims to avoid activities that irritate the wrist and hand.
Orthopaedic experts at UPMC may recommend periods of rest at first for relief.
Since the carpal tunnel syndrome worsens over time, further treatment methods seek to:
- Manage pain.
- Preserve and maximize function.
- Stop the progression of the nerve swelling.
Nonsurgical treatments for carpal tunnel syndrome
Treatment plans often begin with nonsurgical methods, such as:
- Activity modifications.
- Anti-inflammatory medications.
- Rest.
- Steroid injections.
- Wearing a splint or brace at night to reduce motion and support the nerve.
Repair surgery for carpal tunnel syndrome
If your symptoms persist even after nonsurgical treatments, your doctor may recommend carpal tunnel syndrome surgery.
Some common surgical treatments your doctor may choose, based on your symptoms and syndrome severity, may include:
- Carving out a nerve's tunnel.
- Ligament shortening.
- Tendon and nerve lengthening.
During surgery, the surgeon will cut the ligament that is at the top of the carpal tunnel and squeezing your nerve. Your wrist and fingers will keep working normally afterward.
This procedure can be done in an office, surgery center, or hospital. There are different ways to do the surgery, including open and minimally invasive options, such as endoscopic (with a camera) and ultrasound-guided.
Many people have local anesthesia, which provides pain relief directly at the surgical site, and don’t go to sleep for the surgery. Our plastic surgery hand team uses the most advanced and innovative techniques to help you recover as fast as possible.
Recovery after surgery
Using a brace or having surgery can quickly relieve nighttime tingling. If you have constant numbness or weakness in your thumb, those changes could be permanent. Your nerve can continue to improve for two to three years after surgery.
Following any sort of surgical treatment of carpal tunnel syndrome, you should expect:
- Pain.
- Some bruising.
- Soreness.
- Swelling.
With some of the ways of doing surgery, you can resume your activities as soon as the next day. It's important to keep using your hand for everyday activities right after surgery to prevent stiffness and speed up your recovery.
Doctors may instruct you to:
- Elevate your hands.
- Move or exercise your hands to increase circulation.
- Wear a brace for three to four weeks.
Failure to follow doctors' post-op orders can lead to further problems and related complications.
If your carpal tunnel syndrome was severe, the nerve might not fully recover, and you could still have some numbness or weakness. Talk about this possibility with your doctor.
