What is carpal tunnel?

Bitterroot Orthopedics and Sports Medicine
A service of Marcus Daly Memorial Hospital
Timothy Woods, MD
1200 Westwood Drive
Hamilton, MT 59840
(406) 375-4868

What is carpal tunnel?
Patient: "Dr. Woods I think I have carpal tunnel."
Dr. Woods: "As a matter of a fact, you do. Everyone has one. The question is do you have carpal tunnel syndrome."

Carpal tunnel syndrome is a common source of hand numbness and pain. It is more common in women than men. The carpal tunnel is a narrow tunnel-like structure in the wrist. The bottom and sides of this tunnel are formed by wrist (carpal) bones. The top of the tunnel is covered by a strong band of connective tissue called the transverse carpal ligament. The median nerve travels from the forearm into the hand through this tunnel in the wrist. The median nerve controls feeling in the palm side of the thumb.

Carpal tunnel syndrome occurs when the tissues surrounding the flexor tendons in the wrist swell and put pressure on the median nerve. This swelling of the synovium narrows the confined space of the carpal tunnel, and over time, crowds the nerve. Many things contribute to the development of carpal tunnel syndrome:

Heredity is the most important factor-carpal tunnels are smaller in some people and this trait can run in families.

Hand use over time can play a role.

Hormonal changes related to pregnancy can play a role.

Age-the disease occurs more frequently in older people

Medical conditions, including diabetes, rheumatoid arthritis, and thyroid gland imbalance can play a role.

However, in most cases of carpal tunnel syndrome, there is no single cause.

The most common symptoms of carpal tunnel syndrome include:

Numbness, tingling, and pain in the hand

An electric shock-like feeling mostly in the thumb, index and long fingers

Strange sensations and pain traveling up the arm toward the shoulder

To determine whether you have carpal tunnel syndrome, your doctor will discuss your symptoms and medical history. He or she will also examine your hand and perform a number of physical tests, such as:

Checking for weakness in the muscles around the base of your thumb

Bending and holding your writs in positions to test for numbness or tingling in your hands (Phalen Test)

Pressing down on the median nerve in the wrist to see if it causes any numbness or tingling

Tapping along the median nerve in the wrist to see whether tingling is produced in any of the fingers (Tinel Sign)

Testing the feeling in your fingers by lightly touching them when your eyes are closed.

For most people, carpal tunnel syndrome will progressively worsen without some form of treatment. It may, however, be modified or stopped in the early stages. For example, if symptoms are clearly related to an activity or occupation, the condition may not progress if the occupation or activity is topped or modified.

If diagnosed and treated early, carpal tunnel syndrome can be relieved without surgery. In cases where the diagnosis is uncertain or the condition is mild to moderate your doctor will always try simple treatment measures first.

A brace or splint worn at night keeps the wrist in a neutral position this prevents the nightly irritation to the median nerve that occurs when wrists are curled during sleep.

Surgery may be considered if you do not gain relief from nonsurgical treatments. The decision whether to have surgery is based mostly on the severity of your symptoms.

In more severe cases, surgery is considered sooner because other non-surgical treatment options are unlikely to help.

In very severed, long-standing cases with constant numbness and wasting of your thumb muscles, surgery ma be recommended to prevent irreversible damage.

The most common risk from surgery for carpal tunnel syndrome include: bleeding, infection and nerve injury.

Most patient's symptoms improve after surgery, but recovery may be gradual. On average, grip and pinch strength return by about 2 months after surgery. Complete recovery may take up to a year. If significant pain and weakness continue for more than 2 months, your physician may instruct you to work with a hand therapist. In long-standing carpal tunnel syndrome, with severe loss of feeling and/or muscle wasting around the base of your thumb, recovery is slower and might not be complete. Carpal tunnel syndrome can occasionally recur and may require additional surgery.

The AAOS (American Academy of Orthopaedic Surgeons) published in April 2016 a list of nine strong recommendations regarding carpal tunnel syndrome and its treatment.

1. Muscle wasting is strongly associated with carpal tunnel syndrome.
2. Use of any one single test to diagnose is not recommended.
3. BMI (weight) and repetitive use increase risk of carpal tunnel syndrome.
4. Using splints should improve patient outcomes.
5. Using steroid injections should improve patient outcomes.
6. There is no evidence to support magnet therapy.
7. Surgical release should relieve symptoms and improve function.
8. Surgical treatment should have a greater benefit in the long term than non-surgical
9. There is no benefit from immobilization after surgery.

If you have questions about carpal tunnel syndrome, ask your health care provider or contact Timothy Woods, MD at Bitterroot Orthopedics and Sports Medicine, (406)375-4868, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier community!