Features June 2017 Issue

Hand Pain May Be Carpal Tunnel Syndrome

Often occurring for unknown reasons, carpal tunnel syndrome is best addressed early.

Pain and numbness in your wrist and hand may be a sign of arthritis, but it could also be carpal tunnel syndrome (CTS). The classic symptom that separates CTS from arthritis is waking up at night with numbness and tingling mainly in the thumb and index and ring fingers, but not the little finger.

“It’s a feeling that makes you want to hang your hand over the side of the bed and shake it off,” says Arthritis Advisor Editor-in-Chief and orthopaedic surgeon Steven Maschke, MD. Symptoms may also occur throughout the day. “A common symptom is driving a car and suddenly needing to let go of the steering wheel and shake your hand because it feels like your hand has fallen asleep,” he says.

Compressed Nerve

The carpal tunnel is a passageway in the wrist. Traveling through it are a main nerve to the hand (called the median nerve) and nine tendons that allow you to bend your fingers and thumb. The wrist bones make up the floor of the tunnel and the roof is a tight band of tissue called the transverse carpal ligament.

“There are a lot of structures in this very tight space,” says Dr. Maschke. CTS occurs when inflammation in the carpal tunnel compresses the nerve, causing the tingling and numbness. With advanced CTS the hand becomes weak, often causing you to drop objects. The fleshy part of the thumb muscle may cave in from atrophy.

Hand Nerve

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The nerve that goes to the fingers runs through a narrow space in the wrist.

In the past it was thought that repetitive movements, like typing or working on an assembly line, could cause CTS. “That’s been shown not to be the case,” says Dr. Maschke. However, heavy vibrations, like from running a jackhammer, over several years can contribute to CTS.

Most of the time, people get CTS for unknown reasons. It may also result from trauma to the wrist or a health condition that increases risk. For example, people with rheumatoid arthritis, which can cause swelling around the tendon in the wrist, are susceptible to getting CTS. Diabetes and thyroid disorders may also increase the chances of getting CTS.

Diagnosing CTS

A doctor can usually diagnose CTS by recognizing the characteristic symptoms and conducting a physical examination. “We may tap on the wrist or put some pressure on it to see if we can elicit the symptoms in the fingers,” says Dr. Maschke.

If other causes of symptoms are possible, such as nerve damage from diabetes or problems in the cervical spine, a test of the conductivity of the nerve (called an electromyogram) may be done.

Don’t Wait to Treat

Treatment depends on the severity. If symptoms are waking you up at night and they come and go throughout the day, try wearing a wrist brace at night that prevents the wrist from bending. “Sometimes just taking the pressure off at night takes care of it,” says Dr. Maschke. Nerve gliding exercises can also be helpful.

If symptoms persist, a corticosteroid injection may ease pain. This almost always provides only temporary relief. If these measures fail or symptoms are very severe (meaning you can’t feel anything with your fingers) or rapidly worsen, it’s time for surgery without delay. “If CTS gets too advanced, no treatment will provide complete relief,” says Dr. Maschke.

The surgery releases the transverse carpal ligament, which increases the space in the carpal tunnel. It can be done either as an open procedure with a small incision in the palm or with an endoscope through an incision at the wrist. It usually takes about three weeks to return to normal activities.

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