FAQ’s on Carpal Tunnel Syndrome

When pressure is applied on the median nerve in your wrist, Symptoms of Pain, tingling, and gripping problems may start to appear in your wrist and hand due to Carpal Tunnel Syndrome (CTS). The median nerve has control over the sensations and feeling in your thumb and first three fingers (but not your pinkie or little finger).

Located between the base of the hand and the wrist is the carpal tunnel, and houses the median nerve of the body. The tunnel is comprised of ligaments, tendons, nerves and bones. When damaged or inflamed, excess pressure is placed upon the median nerve, leading to complications in the hand. Compression of the median nerve can drastically impact the hand’s functionality.

What causes Carpal Tunnel Syndrome?

CTS is the cumulative effect of many collective factors affecting the wrist, and it is possible to be susceptible to this condition from birth due to congenital narrowing of the carpal tunnel.

Repetitive hand motion, activities that strain the carpal muscles or place consistent pressure on the carpal tunnel can lead to the development of CTS. CTS can also result from direct damage to the wrist through injury (e.g fracture) or it can be an after-effect of hormonal imbalances in the body such as arthritic or diabetic inflammation or swelling.

The symptoms of Carpal Tunnel Syndrome

The most common symptom felt by patients is numbness in the palm or fingers, or an itchy feeling that occurs between the palm and wrist. Secondly, this numbness may spread to the fingers (primarily in the middle and index fingers, and the thumb) leading to a loss of dexterity.

Other common CTS symptoms include swelling of the wrist, warmth or tenderness to the touch at the location of the median joint, and a gradual loss of hand strength as the muscles atrophy. It is common for patients to feel symptoms in their dominant hand first due the greater amount of use it receives.

Symptoms seem to be reported to initially occur at night and can radiate into the elbow.

How is Carpal Tunnel Syndrome diagnosed?

CTS is a gradual degradation so the earlier it can be diagnosed and treated, the better. The first step taken by the Dallas pain physician is to rule out any other possible conditions of the hand, wrist, and arm that may produce the symptoms the patient is experiencing.

Following this, the wrist itself will be evaluated for swelling, warmth, discoloration, and tenderness to touch. If a patient is experiencing a loss in function of the hand, tests to determine the strength of the fingers will be administered in order to examine for muscular atrophy. There are also specific CTS tests that can be used to mirror the stimuli of CTS to see if the patient responds with the symptoms being experienced.

An EMG/NCS may be necessary to confirm the diagnosis. Typically, between the physical exam, history and the EMG, the diagnosis of carpal tunnel syndrome is confirmed.

Treatment options for Carpal Tunnel Syndrome

Treatment will vary based on the extent of CTS present for the patient. Keeping the hand in a neutral position to alleviate the pressure on the median nerve is key. Interestingly, pressure in the carpal tunnel is increased both during flexion and extension. An example of a neutral position is that of holding a glass of water.

The first step in medical treatment is to provide OTC medication (pain relievers and anti-inflammatory drugs) to help provide symptomatic relief, while icing the area in 10 to 15-minute sessions. Once pain has subsided, patients will be placed in physical therapy to strengthen the muscles of the wrist in a clinical setting. The goal being to help the patient develop methods of using the wrist that will not trigger symptomatic responses.

Steroid injections into the carpal tunnel may help decrease the swelling and provide significant relief to help patients avoid surgery.

Surgical correction is one of the most performed surgeries in the country and is usually done for patients who have the late stages of CTS, or fail conservative treatments.