South Florida Hand and Orthopaedic Center

Physician Forum

Carpal tunnel syndrome is characterized by numbness, pain or tingling sensation of the thumb and/or first two fingers.

It is a very common problem for people who use their hands for long periods of time in their work, such as on assembly lines or in textile manufacturing. It also commonly develops spontaneously in the general population. The underlying cause is a compressed nerve at the wrist.

Repetitive use of the hand and upper extremity may cause a swelling of tendons which can then press on the median nerve as it goes through the carpal tunnel. This may cause significant discomfort and, on occasion, cause weakness and loss of sensation in the hand. Both hands may be affected though one side is usually worse.

Some people complain of their fingers being stiff and joints swollen. Others claim to be clumsy in using their hands primarily on the basis of either weakness, or more commonly, because they do not have normal feeling in their fingers and actually begin dropping objects due to their loss of sensation. A large percentage of complaints occur at night or in the early hours of the morning. It may actually wake some people from sleep.

One can sometimes find relief by shaking the hand or by running hot water over it. Symptoms are usually intermittent when the condition first occurs and may actually disappear for months at a time. Others will have symptoms continue without relief. Some situations can worsen this condition. Such activities usually involve repeated bending of the wrist. Holding a newspaper with the wrist bent, driving a car for a distance with the hands on the steering wheel or wringing clothes can result in making the symptoms worse.

If discovered early, carpal tunnel syndrome can be treated. Despite the obvious features of this problem, the diagnosis of carpal tunnel syndrome is frequently delayed.

Most people that suffer with carpal tunnel syndrome do not have an underlying illness which predisposes them to this condition. Some conditions however, are associated with this disorder. Women are more commonly affected than men and the disease occurs in all age groups.

There is an increased incidence around menopause, suggesting hormonal relationship. There is also an increased incidence in pregnancy which is related to fluid retention. Some rheumatologic conditions, such as rheumatoid arthritis, can increase the amount of inflammation of the tendons within the carpal tunnel.

Some fractures of the wrist can alter the normal anatomy of the bones making up the borders of the carpal tunnel resulting in median nerve compression. Carpal tunnel syndrome may also be associated with certain metabolic conditions such as diabetes or thyroid disorders.

Diagnosis by a physician is made by obtaining an adequate history and through a physical examination. Confirmation is possible by obtaining specific electrodiagnostic studies of the nerves in the arm to evaluate their function.

Three different treatment approaches are effective in treating this disorder. The first approach includes immobilization through a splinting program. As symptoms are worsened by wrist motion, preventing such motion often gives relief. The patient wears a splint maintaining the wrist in a straight or neutral positoin. The fingers are left free, which allows most activities to be carried out unimpeded.

The splint may be used at all times but is especially effective at night when a majority of symptoms occur. Some patients wear a splint for a number of weeks with good relief and find the symptoms do not recur after the splint is discontinued.

Injections of anti-inflammatory medication, such as cortisone, is sometimes effective, especially in patients with symptoms of shorter duration. This is usually used in combination with a splinting program. Cortisone injection may provide permanent cure but a significant percentage of symptoms do recur over time.

Sometimes surgery is necessary to open up the carpal tunnel, relieving pressure on the median nerve. This procedure is carried out on an outpatient surgical basis. It may be performed under local or general anesthetic depending upon preference of the surgeon and patient. New minimally invasive surgical techniques are available. It is up to the discretion of the surgeon to determine which surgical technique is right for you.

The hand is immobilized in a splint for 2-3 weeks after such surgery to allow for adequate wound healing. There is generally minimal discomfort. Relief is obtained in most patients with uncomplicated carpal tunnel syndrome.

Splinting will be effective in early disease. Cortisone injection gives lasting relief in approximately one half of patients that fail a trial of splinting and do not demonstrate long standing nerve compression.

Surgical treatment is effective in more than 90 percent of cases, however, where there are other conditions such as diabetes or rheumatoid arthritis, residual symptoms may occur from these underlying disorders.

Carpal tunnel syndrome is an extremely common condition found in the work place and in the general population., Once diagnosed, effective measures can be taken to provide successful treatment in the vast majority of cases, especially when treated early.