Bitterroot Orthopedics and Sports Medicine
A service of Marcus Daly Memorial Hospital
Timothy Woods, MD
1200 Westwood Drive
Hamilton, MT 59840
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
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.
- Muscle wasting is strongly associated with carpal tunnel syndrome.
- Use of any one single test to diagnose is not recommended.
- BMI (weight) and repetitive use increase risk of carpal tunnel syndrome.
- Using splints should improve patient outcomes.
- Using steroid injections should improve patient outcomes.
- There is no evidence to support magnet therapy.
- Surgical release should relieve symptoms and improve function.
- Surgical treatment should have a greater benefit in the long term than
- 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