If you’re experiencing pain in your hand or wrist that just won’t go away, you may be frustrated and longing for relief. More than anything, you likely want to know what’s causing the pain. One probable cause of that pain is carpal tunnel syndrome.
Carpal Tunnel Syndrome Defined
Carpal tunnel syndrome is a pressure-related problem. It occurs when swelling or narrowing of the carpal tunnel—a structure formed by small bones in the wrist—pinches the median nerve, which passes through the tunnel. This nerve gives feeling to the palm side of most of your fingers, including the thumb, and controls muscles at the base of the thumb.
“Most of the time, we don’t know what causes carpal tunnel syndrome,” said Ramon DeJesus, MD, hand surgeon and director of plastic surgery at UM Upper Chesapeake Health. “It can be related to certain jobs that involve overuse of the hand and wrist, such as factory work, or spending a lot of time at a keyboard with the wrist in a poor position. People with diabetes and thyroid conditions are more likely to develop carpal tunnel syndrome.”
Women’s risk of carpal tunnel syndrome is triple that of men’s, according to the Office on Women’s Health. Researchers are working to understand exactly why the risk is so much higher for women. Genetics, hormonal changes and smaller wrist bones may be contributing factors.
Symptoms of Carpal Tunnel Syndrome
Most people with carpal tunnel syndrome have one or more of these symptoms in their hand and wrist:
- Burning
- Numbness
- Pain
- Tingling (a “pins and needles” sensation)
“Carpal tunnel syndrome usually starts with pain that can occur with use or at rest,” Dr. DeJesus said. “A tingling sensation can be quite upsetting for some people, as it can wake them at night and affect their quality of sleep. Over time, individuals can lose strength and dexterity in the hand and wrist, which can cause them to drop things and affect their daily activities and work performance.”
The Importance of Early Diagnosis
If you experience carpal tunnel syndrome-like symptoms, speak with your primary care physician, who may refer you to a hand and wrist specialist.Â
Early diagnosis is key for two reasons. First, if you catch carpal tunnel syndrome early, conservative treatments may be enough to provide relief. Second, if it turns out surgery is the most appropriate treatment option for you, you’re likely to have more successful results if you seek care quickly. The longer you wait, the greater the likelihood you’ll experience muscle damage that won’t improve with surgery.
Treatment: From Behavior Changes to Surgery
If you have carpal tunnel syndrome, a variety of nonsurgical treatments may provide relief, including:
- Avoiding repetitive hand and wrist motions
- Changing your workspace to make it more ergonomic
- Performing hand and wrist exercises as instructed by a physical therapist
- Taking over the counter anti-inflammatories
- Wearing a splint to keep from bending your wrist, especially at night
If you have moderate or severe carpal tunnel syndrome, have experienced muscle loss as a result of the condition, or haven’t found relief from conservative treatments, you may be a candidate for surgery. Carpal tunnel surgery relieves pressure on the median nerve. It is an outpatient procedure that a hand specialist can perform using an open or minimally invasive approach.
“I perform most carpal tunnel surgeries using a local anesthetic,” Dr. DeJesus said. “The surgery takes as little as five to 10 minutes when I perform it endoscopically. One incision, less than a half inch wide, is made at the wrist. The endoscope is guided through the incision. The surgeon then cuts the carpal ligament and releases the pressure on the median nerve. Carpal tunnel syndrome is a compression problem, so I decompress the nerve by cutting a ligament above it. That gives the nerve more room.”
Your hand may swell after surgery, and you may need to ice and elevate your hand for the swelling to go down. Expectations after surgery depend, in part, on the severity of carpal tunnel syndrome and whether you caught it early.
“For patients who have already experienced muscle atrophy, it’s unlikely they’ll get their muscle back, but pain and other symptoms can improve,” Dr. DeJesus said. “If you’re a candidate for surgery, the sooner you get it, the better. Younger people have a better capacity for the nerve to regenerate.”
Other Conditions That Can Cause Hand and Wrist Pain
Carpal tunnel syndrome isn’t the only condition that can cause pain or other symptoms in your hand and wrist. According to Dr. DeJesus, other possible causes include:
- Arthritis of the wrist or thumb
- De Quervain’s tenosynovitis, which is swelling of tendons in the wrist
- Diabetic neuropathy, which damages nerves in the hands
- Nerve impingement in the elbow, forearm or spine
- Thoracic outlet syndrome, which is the compression of nerves and blood vessels in and around the shoulders and top of the chest
- Trigger finger or trigger thumb, which can cause pain or locking in the fingers during bending
An accurate diagnosis is key, and a hand and wrist specialist can determine whether your symptoms are due to carpal tunnel syndrome or something else. That’s the first step to figuring out which treatment can help.
