Carpal Tunnel syndrome

Carpal tunnel syndrome is a common condition where one of the major nerves to the hand (the “median nerve”) gets compressed as it passes through a tunnel leading from the forearm to the palm. Common causes include trauma, overuse, or pregnancy. However, many times the cause is unknown.

Symptoms typically include numbness and tingling in the thumb, index, and middle finger. This "buzzing" sensation, that the hand has "fallen asleep", can awaken people at night, causing them to shake the hand, hold it up in the air, or off the side of the bed to alleviate the symptoms. The "pins and needles" sensation can also be felt while driving, using a computer, doing one's hair, or holding items such as a book, phone or tablet. Some individuals may also note pain in these fingers, weakness in the hand, or loss of dexterity (e.g. difficulty with buttons or picking up small objects).

Watch this 2-minute animation to learn more about how carpal tunnel affects your hand. Video from www.HandCare.org

Diagnosis

  • Carpal tunnel syndrome can oftentimes be diagnosed by talking with your doctor and having them examine your hand and arm. Occasionally a nerve test (EMG or nerve conduction study) can be used to assess the function of the nerve. This test can help determine if the nerve is being pinched, and where it is being compressed.

 

Non-surgical treatment

  • Modify activities - improving the posture or position of the hand and wrist with activities such as computers, driving, reading, etc can minimize symptoms.

  • Wear a wrist splint at night - sleeping with the wrist in a bent position will decrease the diameter of the carpal tunnel, resulting in the nerve being pinched. A wrist splint keeps the wrist in a straight/neutral position. This can improve the quality of your sleep.

  • Steroid injection - a cortisone injection into the carpal tunnel bathes the medial nerve in a strong anti-inflammatory fluid, this can shrink down a swollen and inflamed nerve, which decreases the pain and tingling.

  • Median nerve gliding exercises (see below) - these stretches should be performed several times per day. They can increase the health of the nerve by helping normal gliding, decreasing adhesions, and opening up the carpal tunnel.

Median nerve gliding exercises. 1) Begin with your wrist in a neutral position, fingers and thumb bent into a fist, with your thumb facing you. 2) Extend your fingers and thumb into a straight, neutral position. 3) Keeping your fingers and thumb straight, bend your wrist so that your palm faces up. 4) Keeping your hand in the same position, extend your thumb away from your hand. 5) Keeping your hand and fingers in the same position, rotate your wrist so that your palm faces away from you. 6) While in position 5, gently pull down on your thumb with your free hand. Hold each position for 5 seconds, repeat series 3 to 5 times.

Surgical treatment

  • Traditional “open” carpal tunnel release - performed through an incision overlying the carpal tunnel along the palm of the hand. Typically the incision is less than 1 inch. Underneath the skin, the "roof" of the tunnel is released with a scissors and/or knife. This increases the diameter of the tunnel and eliminates the compression.

  • Endoscopic carpal tunnel release - performed through an incision in the forearm. A camera is inserted into the carpal tunnel. A knife blade is attached to the camera, which is used to release of roof of the carpal tunnel from the inside. Unfortunately, in some cases, inserting a camera into the already tight carpal tunnel can irritate the nerve.

  • I typically perform an “open” carpal tunnel release, as I find this to have less risk to injuring/irritating the median nerve. I find the invasiveness of the two procedures and their recovery to be very similar.

  • The 1 inch incision is closed with absorbable sutures placed underneath the skin, and Dermabond (medical grade "Super Glue") is used to seal the incision. A bandage is applied which remains in place for 3 days.

  • The hand can be used for normal light activities immediately (using a computer, phone, grooming, eating/drinking, etc).

  • Patients can get the incision wet once the bandage is removed on the 3rd day, as it is “sealed” by the glue. 

  • More demanding activities (e.g. lifting weights, gardening, manual labor) should be avoided until the skin heals (~10 days).

  • The intermittent pin-and-needles feeling, tingling sensations, and associated pain starts improving immediately after surgery once the pinched nerve has been released.

  • If the nerve had been damaged from being pinched over a period of time, continued improvement in nerve function can be slower. Nerves repair themselves at a rate of 1 inch per month, so it may be many months or up to a year for symptoms of weakness and numbness to maximally improve.


Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.