Carpal Tunnel

A Syndrome That Gets on your Nerves

We work hard. And sometimes our bodies just can’t keep up. That’s especially true when it comes to our hands.

Whether you spend your days typing, tapping, turning or twisting, our hands are the tools we use to put food on the table and keep our worlds moving.

The last thing we need is pain when we use them.

It may not be arthritis

When our hands and fingers ache, it’s easy to assume arthritis, which is joint inflammation that causes pain and stiffness. However, it could be another condition known as carpel tunnel syndrome.

The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. Carpel tunnel syndrome occurs when one of the major nerves in that passageway (the median nerve) is squeezed or compressed. When there is pressure on the median nerve, you will feel numbness, tingling, and weakness in your hand and arm. And it gets worse over time.

Symptoms start slowly

You probably don’t remember when your pain and discomfort started. That’s because carpal tunnel syndrome symptoms start gradually.

Major symptoms include:

• Tingling or numbness  - This usually occurs in the thumb and index, middle or ring finger, but not the little finger. It may even feel like an electric shock in these fingers, and the sensation may travel from the wrist up the arm. These symptoms often occur while you’re driving or holding your phone, or the sensation may wake you from sleep. Many people shake out their hands to relieve their symptoms. The numb feeling can become constant over time.
• Weakness - You may experience weakness in the hand and drop objects. This may be due to the numbness in the hand or weakness of the thumb's pinching muscles (also controlled by the median nerve).
  

What causes it

Anything that squeezes or irritates the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve. So can swelling and inflammation caused by rheumatoid arthritis.

Many times, there’s no single cause of carpal tunnel syndrome. It may be a combination of risk factors that causes the condition, which may include:

• Anatomic issues - A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist can alter the carpal tunnel and put pressure on the median nerve. You may also have a smaller carpal tunnel than others, which puts you more at risk.
• Changes in body fluid - Fluid retention may increase the pressure within the carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Pregnancy-related carpal tunnel syndrome generally gets better on its own after delivery.
• Gender - Carpal tunnel syndrome is generally more common in women.
• Inflammatory conditions - Rheumatoid arthritis and other conditions that cause inflammation can affect the lining around the tendons in the wrist and put pressure on the median nerve.
• Medication - Some studies have shown a link between carpal tunnel syndrome and using anastrozole (Arimidex), a drug used to treat breast cancer.
• Nerve-damaging conditions - Some chronic illnesses, such as diabetes, can increase the risk of nerve damage, including damage to the median nerve.
• Obesity - Being overweight may be a factor.
• Other medical conditions - Certain conditions, such as menopause, thyroid disorders, kidney failure and lymphedema may increase the chances of carpal tunnel syndrome.
• Workplace environment -  Working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist can cause harmful pressure on the median nerve or worsen existing nerve damage, especially in cold environments. There has not been significant evidence to prove computer use as a risk factor for carpal tunnel syndrome, although it can cause a different form of hand pain. 

Prevention

Unfortunately, there are no proven strategies to prevent carpal tunnel syndrome. But there are things you can do to lessen stress on your hands and wrists, including:

• Loosen your grip - If your work involves a cash register or keyboard, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink.
• Take short breaks - Gently stretch and bend hands and wrists periodically. This is especially important if you use equipment that vibrates or that requires you to exert yourself.
• Form over function - Avoid bending your wrist all the way up or down. A relaxed middle position is best. Keep your keyboard at elbow height or slightly lower.
• Improve your posture - Bad posture causes your shoulders to roll forward, shortening the neck and shoulder muscles and compressing nerves in your neck. This can affect the wrists, fingers and hands, and can cause neck pain.
• A new mouse in the house - Make sure your computer mouse is comfortable and doesn't strain your wrist.
• Keep your hands warm - If you can't control the temperature, put on fingerless gloves that keep the hands and wrists warm.
  

Treatment

You should seek treatment for carpal tunnel syndrome as early as possible after symptoms start. In the early stages, simple things that you can do for yourself may make the problem go away, such as:

• Wrist splinting - A splint that holds the wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) - NSAIDs, such as ibuprofen (such as Advil), may offer short-term relief.
• Corticosteroids - Your provider may inject the carpal tunnel with a corticosteroid (such as cortisone) to relieve pain. Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve.

Surgery may be needed if symptoms are severe or don't respond to other treatments. The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve. After the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve. This internal healing process typically takes several months, but the skin heals in a few weeks.

Don’t wait

If you have signs and symptoms of carpal tunnel syndrome that interfere with your normal activities and sleep patterns, talk to your doctor immediately. You don’t have to live with pain and numbness. Plus, permanent nerve and muscle damage could occur without treatment, so don’t wait.