Five things to know about carpal tunnel syndrome

St. Joseph’s/Candler Neurologist Dr. Ryon Poston explains causes, diagnosing and treating this common nerve disorder

Do you find your hands often feeling weak? Maybe there’s a constant feeling of ‘pins and needles’ in your fingers.

One possible diagnosis is carpal tunnel syndrome. Carpal tunnel syndrome is when the median nerve is compressed as it passes through the carpal tunnel. The carpal tunnel is an opening in your wrist that is formed by the carpal bones on the bottom of the wrist and the transverse carpal ligament across the top of the wrist.

“The tunnel is tight anatomically,” explains Dr. Ryon Poston, neurologist with St. Joseph’s/Candler Physician Network - Neurology. “It has bone on the bottom, bone on each side and a thick ligament on top. The median nerve shares this tunnel with nine tendons.”

When the median nerve gets irritated or swollen it can lead to carpal tunnel syndrome, also known as an entrapment neuropathy. Carpal tunnel syndrome is very common, with an estimated three million cases diagnosed each year.

Who’s at risk of carpal tunnel syndrome?

If you’ve never had it, chances are you know someone who has. Repetitive motion in certain job fields from painting and carpentry to data entering and keyboarding can lead to median nerve injury.

Others with this condition may simply have a narrower carpal tunnel than others. The syndrome also could be the result of trauma to the area, such as a broken bone, or a complication of another medical problem, such as diabetes or hypothyroidism.

Women get carpal tunnel syndrome three times more often than men, and it’s a syndrome that most often occurs in adults.

What causes carpal tunnel syndrome?

Most cases of carpal tunnel syndrome have no specific cause, but any or all of the below may be part of the cause:

• Frequent, repetitive, small movements with the hands, such as typing or using a keyboard
• Frequent, repetitive, grasping movements with the hands such as with sports and other physical activities
• Joint or bone disease; for example, arthritis, osteoarthritis or rheumatoid arthritis
• Hormonal or metabolic changes, such as menopause, pregnancy or thyroid imbalance
• Changes in blood sugar levels
• Other conditions of the wrist, such as sprains, strains, dislocation, breaks or inflammation
• Family history of carpal tunnel syndrome

What are the symptoms of carpal tunnel syndrome?

The most common symptoms of carpal tunnel syndrome are:

• Weakness when grasping objects with one or both hands
• Pain or numbness in one or both hands
• ‘Pins and needles’ feeling in the fingers
• Swollen feeling in the fingers
• Burning or tingling in the fingers, especially the thumb and index and middle fingers
• Pain or numbness that is worse at night, interrupting sleep

The symptoms of carpal tunnel syndrome may seem like other health conditions or problems. Be sure to talk to your physician about any symptoms or pain you experience.

How is carpal tunnel syndrome diagnosed?

Testing for carpal tunnel syndrome most likely will include a physical exam, nerve conduction studies and an electromyography, or EMG. Dr. Poston says he may tailor tests slightly to confirm a diagnosis and to rule out other possible nerve issues.

For the nerve conduction study, electrodes are placed over the muscle supplied by the nerve. Then, through electrical stimulation, the strength and speed, or lack thereof, in the nerve’s response is recorded.

In an EMG, a tiny needle is inserted into the muscle to evaluate its electrical activity.

“In mild cases, the signal is getting through the nerve, but is often slow,” says Dr. Poston. “In more severe cases, some of the signal isn’t getting through at all.”

How do you treat carpal tunnel syndrome?

The severity of your diagnosis – along with age and overall health – will help determine the best course of treatment.

“For carpal tunnel, patients can wear splints that help keep their wrist straight,” Dr. Poston says. “This can be very effective at night, when people would normally flex their wrists as they move into different sleeping positions, pinching on the nerve without knowing it. In milder cases, just this change alone can really go a long way to helping people.”

Other treatments, such as physical therapy or steroid injections into the wrist to reduce inflammation, can also relieve symptoms.

For severe cases, surgery is an option. This surgery is called carpal tunnel release and eases the compression on the nerve in the carpal tunnel by cutting the transverse carpal ligament in such a way it gives the median nerve more room to operate correctly.

“I always remind my patients that, even with the best treatments, it can take weeks to months for the nerves to get better,” Dr. Poston says. “But they do get better.”