If your fingers start to tingle, and eventually go numb or begin to hurt, you may have carpal tunnel syndrome, a condition of the median nerve. The median nerve is the nerve that travels down your arm and through your wrist to your thumb and first three fingers.
What is Carpal Tunnel Syndrome?
Your wrist is made of 8 small bones called carpal bones. There is a small tunnel in the carpal bones called the carpal tunnel. The median nerve has to travel through the carpal tunnel to get to your hand. When you have carpal tunnel syndrome, the median nerve is pinched or squeezed as it passes through the carpal tunnel. This causes the tingling, numbness and pain.
In most cases symptoms begin as mild and slowly become worse. Sometimes symptoms affect the arm and shoulder as well as the hand. If left untreated carpal tunnel syndrome can lead to permanent damage.
What causes Carpal Tunnel Syndrome
Carpal Tunnel Syndrome can be caused by swelling of the nerve or narrowing of the carpal tunnel. Some causes are more or less mechanical, such as a repetitive stress injury or an accident that damages the tunnel. Other causes are related to diseases, including rheumatoid arthritis, diabetes, thyroid disease, etc. Heredity is thought to heavily influence who does and does not get the disease. The wide range of potential causes is one of the reasons that Carpal Tunnel Syndrome is so common.
Physical Tests for Carpal Tunnel Syndrome
Diagnosis starts with a physical history and a physical exam. There are three tests, in particular, that are commonly part of the physical exam:
- When performing the Tinel Test, the doctor will tap over your median nerve on the palm side of your wrist. The test is positive if this causes you to have tingling in your fingers.
- During the Phalen’s Test, the doctor will have you raise your elbows out to the side while pressing the backs of your hands together for 30 to 60 seconds. The test is positive if this causes numbness or tingling in your fingers.
- The Carpel Compression Test, involves pressing down on the median nerve in the carpal tunnel for thirty seconds. The test is positive if it causes numbness and tingling in the fingers.
Electrophysiological Tests for Carpal Tunnel Syndrome
Electrophysiological tests measure how well your median nerve is working.
- A Nerve Conduction Study (NCS) measures how well signals are traveling along the nerves in your hand and fingers.
- An Electromyogram (EMG) measures electrical activity in your muscle and checks for damage to your muscles and nerves.
Treatment of Carpal Tunnel Syndrome
If carpel tunnel syndrome isn’t treated, it can cause permanent damage, including loss of motion. There are multiple treatment options, including:
- Wearing a wrist splint at night
- Physical therapy
- Behavioral changes (avoiding activities like knitting, using vibrating tools, etc.)
- Steroid Injections
Carpal Tunnel Surgery
The goal of Carpal Tunnel Surgery is to release the pressure on the median nerve. There are two types of surgical procedures for carpal tunnel surgery: Open Carpal Tunnel Release and Endoscopic Carpal Tunnel Release. They are both usually done on an outpatient basis.
Surgery can be done with a local anesthetic, that only numbs the site of surgery, or with a general anesthetic, that actually puts you to sleep. Recovery time can vary from a few days to a few months. Carpal Tunnel Syndrome (bcm.edu)