Carpal Tunnel Syndrome
A numbness and tingling in the hand and arm caused by a pinched nerve in the wrist.

Anatomy

Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand and forearm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.
In most patients, carpal tunnel syndrome gets worse over time. If untreated for too long, it can lead to permanent dysfunction of the hand, including loss of sensation in the fingers and weakness. for this reason, it is important to diagnose and treat carpal tunnel syndrome promptly. Early symptoms can often be relieved with simple measures like:
Wearing a wrist splint while sleeping
  • Exercises to keep the nerve mobile
  • Avoiding certain activities that aggravate your symptoms
  • A steroid injection into the carpal tunnel
If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.

Cause of Carpal Tunnel Syndrome

Most cases of carpal tunnel syndrome are caused by a combination of factors. Studies show that women and older people are more likely to develop the condition.
Other risk factors for carpal tunnel syndrome include:
  • Heredity. This is likely an important factor. The carpal tunnel may be naturally smaller in some people, or there may be anatomic differences that change the amount of space for the nerve — and these traits can run in families.
  • Repetitive hand use. Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
  • Hand and wrist position. Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve.
  • Pregnancy. Hormonal changes during pregnancy can cause swelling that results in pressure on the nerve.
  • Health conditions. Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.

Symptoms of Carpal Tunnel Syndrome

Symptoms of carpal tunnel syndrome may include:
  • Numbness, tingling, burning, and pain — primarily in the thumb and index, middle, and ring fingers. This often wakes people up at night.
  • Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
  • Pain or tingling that may travel up the forearm toward the shoulder
  • Weakness and clumsiness in the hand — this may make it difficult to perform fine movements such as buttoning your clothes
  • Dropping things — due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)

Treatments of Carpal Tunnel Syndrome

Although it is a gradual process, for most people carpal tunnel syndrome will worsen over time without some form of treatment. For this reason, it is important to be evaluated and diagnosed by your doctor early on. In the early stages, it may be possible to slow or stop the progression of the disease.
Nonsurgical Treatment
If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved without surgery. If your diagnosis is uncertain or if your symptoms are mild, your doctor will recommend nonsurgical treatment first.
Nonsurgical treatments may include:
Bracing or splinting. Wearing a brace or splint at night will keep you from bending your wrist while you sleep. Keeping your wrist in a straight or neutral position reduces pressure on the nerve in the carpal tunnel. It may also help to wear a splint during the day when doing activities that aggravate your symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory medications such as ibuprofen and naproxen can help relieve pain and inflammation.
Activity changes. Symptoms often occur when your hand and wrist are in the same position for too long — particularly when your wrist is flexed or extended.
If your job or recreational activities aggravate your symptoms, changing or modifying these activities can help slow or stop progression of the disease. In some cases, this may involve making changes to your work site or workstation.
Nerve gliding exercises. Some patients may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel. Specific exercises may be recommended by your doctor or therapist.
Steroid injections. Corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the carpal tunnel. These injections often relieve painful symptoms or help to calm a flare-up of symptoms.
  • In patients with mild, early disease, injections may relieve symptoms in the long-term.
  • In those with moderate to severe disease, the positive effects of the injection may be temporary.
A cortisone injection may also be used by your doctor to help diagnose your carpal tunnel syndrome.
Surgical Treatment
If nonsurgical treatment does not relieve your symptoms or provides only temporary relief, your doctor may recommend surgery.
The decision of whether to recommend surgery is based on:
  • The severity of your symptoms
  • Physical exam findings
  • Response to non-operative treatment
  • Results of testing
In long-standing cases with constant numbness and wasting of your thumb muscles, surgery may be recommended to prevent irreversible damage. Surgery may also be recommended if you do not get relief with non-operative treatments and/or demonstrate significant nerve changes on testing.
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