Carpel tunnel syndrome is a common cause of hand and finger pain among adults. It can also cause neurologic symptoms like numbness and tingling. Surgery is not always necessary. Non-surgical treatments often help for less severe cases or ones where pressure on the nerve only recently started. This article discusses this common hand problem and its symptoms, diagnosis, and treatment options.
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What exactly is carpal tunnel syndrome?
Carpal tunnel syndrome is a common cause of hand and finger pain. It often causes numbness and tingling. It is caused by pressure on the median nerve as it passes through a space in the wrist known as the carpal tunnel.
Why do some people develop carpal tunnel syndrome?
Many factors are believed to increase a person’s chance of developing carpal tunnel syndrome. Repetitive use of the hands and wrists can be associated with carpal tunnel syndrome. For example, typing for hours a day at work can be associated with this condition. Other risk factors include certain medical conditions and pregnancy.
What symptoms does a patient experience?
The patient often notices pain, numbness, and/or tingling. She feels these symptoms in the thumb, index, and middle fingers. Often the pain wakes her up at night. Her discomfort can increase with repetitive use of the hand or wrist. The problem can affect just one hand, or it could involve both hands at the same time.
How can a doctor diagnose carpal tunnel syndrome?
The description of symptoms can often alert the surgeon to carpal tunnel. Physical exam tests can help make the diagnosis as well. The surgeon can tap on the wrist to try to irritate the median nerve as it crosses the wrist. The tapping might reproduce tingling in the thumb, index, or middle fingers. The doctor might also hold the wrists flexed for 30 or 60 seconds to try to recreate the patient’s pain, numbness, and tingling.
X-rays often show no abnormalities. Nerve conduction studies can identify compression of the median nerve within the carpal tunnel.
Can carpal tunnel syndrome be treated without surgery?
Symptoms often improve without surgery. Usually non-surgical treatments are tried first. Anti-inflammatory medications can decrease the inflammation of tendon sheaths within the carpal tunnel. They can decrease pressure on the median nerve and therefore relieve some of the patient’s pain. Wearing a wrist splint at night (or even during the day) that keeps the wrist in a neutral position can minimize discomfort with activities. Cortisone shots into the area can also decrease pain, numbness and tingling.
What does surgery for carpal tunnel syndrome involve?
Surgery consists of releasing the ligament that serves as the roof of the carpal tunnel. Releasing that ligament decreases pressure on the median nerve. That surgery can be performed arthroscopically or through a small incision on the wrist. The skin is then closed.
What is the typical recovery?
The patient often wears a splint to protect the wrist and hold it in a neutral position for a week or more. She then works on range of motion and strength of the wrist, hand and fingers. She can resume daily activities as her hand and wrist function improve. Pain can decrease quickly, but occasionally full return to baseline can take months.
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