“My hand hurts; I think I have carpal tunnel syndrome.” Orthopedists all over America hear this from their patients everyday, often followed by the patient’s assertion that their pain has been caused by typing on a computer keyboard all day. Entire mini-industries have sprung up to support this myth that carpal tunnel syndrome is a work-related injury, rather than a medical condition, yet numerous scientific studies have shown that there is no relationship between typing and the incidence of carpal tunnel syndrome. And although using a badly positioned computer keyboard or mouse can lead to wrist pain from strain or tendinitis, it is not necessarily carpal tunnel syndrome.
Carpal tunnel syndrome (CTS) is a compression neuropathy – a condition of the peripheral nervous system – that is caused by an increase in pressure on the median nerve in the hand and wrist. The carpal tunnel is actually a space in the wrist surrounded on 3 sides by bone and covered with a ligament through which 9 tendons and one nerve – the median nerve – travel to the fingers. This nerve supplies sensation to the thumb, index, middle, and half of the ring finger, while conducting nerve impulses to the muscles that control the thumb.
Numbness, tingling, or burning in the hand, particularly at night, localized pain over the carpal tunnel in the palm and wrist, or pain that periodically radiates towards the shoulder are all potential indicators of carpal tunnel syndrome. Symptoms are oftentimes aggravated by grasping activities, such as driving a car, holding a book or newspaper, and grasping a telephone.
When the median nerve is compressed, it results in increased sensitivity, tingling, pain, weakness, or numbness in the fingers, hand, and wrist; the pinky remains largely unaffected. The predisposing factors that cause median nerve compression and carpal tunnel syndrome are still largely unknown, but there is a higher incidence of carpal tunnel syndrome in patients with diabetes or rheumatoid arthritis. Pregnant women are the group at highest risk for CTS.
A clinical examination and review of a patient’s history is the best way to diagnose CTS. Your physician may perform simple sensory and strength testing, along with some more specialized diagnostic tests, such as Tinel’s sign, Phalen’s test, or Durkan’s compression test. In some cases, electrodiagnostic examination (EMGs) may be recommended.
Treatment options range from low-tech solutions – avoiding pressure on the median nerve by altering one’s movements, or splinting or bracing the wrist to avoid prolonged flexion or extension (especially at night) – to corticosteroid injections (in most cases this only provides temporary relief of pain). If these treatments do not resolve symptoms, then surgical release is indicated, which decreases the pressure in the carpal tunnel, thereby improving blood flow and nourishment to the median nerve. Surgical treatment generally leads to excellent outcomes in patients who have failed non-operative therapies, but above all, the key is a correct diagnosis.
If you suspect you may have carpal tunnel syndrome, feel free to give us a call and let one of our experts determine the cause of your pain. You don’t have to suffer!