Carpal tunnel syndrome is a condition caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. The carpal tunnel is a narrow passageway formed by the carpal bones on the bottom and the transverse carpal ligament on the top. This tunnel contains the median nerve and tendons that bend the fingers and thumb.

Common Symptoms

Numbness, tingling, or burning sensation in the thumb, index, middle, and ring fingers. This often starts at night and may wake people up from sleep. Many people notice numbness, tingling, and burning of the fingers when driving, doing their hair, reaching overhead, or holding a book. .

Cause & Anatomy

Common causes include swelling or inflammation of the tendons within the carpal tunnel, anatomical differences in the size of the tunnel, repetitive hand movements, hormonal changes (e.g., pregnancy), and certain medical conditions like diabetes or rheumatoid arthritis.

The median nerve provides sensation to the thumb, index, middle, and half of the ring finger and controls the muscles at the base of the thumb. Compression or irritation of the median nerve within the carpal tunnel can cause numbness, tingling, weakness, or pain in the hand and fingers.

Diagnosis

Medical history and physical examination:
The doctor will ask about symptoms like numbness, tingling, weakness, or pain in the hand and fingers, especially the thumb, index, middle, and ring fingers. They will also inquire about activities that aggravate or relieve the symptoms.

Physical tests may include tapping or pressing on the median nerve, flexing the wrist (Phalen’s maneuver), checking for loss of sensation or muscle weakness/atrophy in the affected hand.

Electrodiagnostic tests:
Nerve conduction study measures how quickly electrical impulses travel through the median nerve. Slower conduction indicates compression of the nerve.

Electromyography (EMG) evaluates the electrical activity in the muscles controlled by the median nerve to detect nerve damage.

Prevention

1. Use Proper Wrist Positioning
   Keep your wrist in a neutral, straight position when performing tasks. Avoid bending the wrist up or down for extended periods.
   Wear a wrist brace or splint, especially at night, to keep your wrist straight.

2. Take Frequent Breaks
   Take short breaks every 20-30 minutes when doing repetitive hand motions. Get up and stretch your hands and wrists.
   Alternate between tasks that use different hand/wrist motions.

3. Use Proper Technique
   Use a light grip when holding objects, and avoid forceful or repetitive grasping.
   Keep your shoulders relaxed and elbows close to your body when typing or using tools.
   Ensure your workstation is ergonomically designed to minimize wrist strain.

4. Stay Warm
   Keep your hands and wrists warm, as cold temperatures can exacerbate symptoms.
   Wear fingerless gloves if working in a cold environment.

5. Stretch and Exercise
   Perform gentle stretching exercises for your hands and wrists throughout the day.
   Strengthen the muscles in your hands, wrists, arms and shoulders.

6. Seek Medical Attention
   See a doctor if you experience numbness, tingling or weakness in your hands to get an early diagnosis and treatment.

Treatment – Nonsurgical

Treatment options include splinting, anti-inflammatory medications, ergonomic adjustments, injections, and surgery (carpal tunnel release) to relieve pressure on the median nerve.

• Bracing or splinting: Wearing a brace or splint at night keeps the wrist in a neutral position, reducing pressure on the median nerve. Splinting may also be done during the day for activities that aggravate symptoms.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications like ibuprofen and naproxen can help relieve pain and inflammation. You need to check with your doctor to see if these medications are ok with your other medical conditions and medications.
• Activity changes: Avoiding or modifying activities that aggravate symptoms, such as repetitive wrist movements, can help slow progression.
• Nerve gliding exercises: Specific exercises that help the median nerve move more freely within the carpal tunnel may provide relief.
• Steroid injections: Corticosteroid injections into the carpal tunnel can temporarily reduce inflammation and pressure on the median nerve.

Surgery

Carpal tunnel release surgery: This is the most common surgical procedure for carpal tunnel syndrome. It involves cutting the transverse carpal ligament to increase the size of the carpal tunnel and relieve pressure on the median nerve. An incision is made in the palm to access and cut the ligament. Surgery is typically recommended if nonsurgical treatments fail to provide adequate relief or if the condition is severe with persistent numbness or muscle wasting.

Rehabilitation

Immobilization and Wound Care

• The hand is initially immobilized with a bulky dressing or splint for 2-14 days to protect the surgical site and allow initial healing.
• The dressing is changed regularly to keep the wound clean and dry.
• Sutures are typically removed 10-12 days after surgery if non-dissolvable.
• Gentle range of motion exercises for the wrist, fingers, and thumb are encouraged immediately after surgery to prevent stiffness.
• Exercises with wrist motion, finger bends, thumb bends, and tendon gliding help restore mobility.

Scar Management

• Massaging the scar with moisturizers or aqueous cream using small circular motions helps prevent tightness and sensitivity, typically starting 2-3 weeks post-op.

FAQ’s

When is surgery recommended?
Surgery (carpal tunnel release) may be recommended if symptoms are severe or persistent, non-surgical treatments fail to provide relief, or there is risk of permanent nerve damage. Nerve conduction tests can help determine if surgery is needed.

How effective is carpal tunnel surgery?
Most people experience reduced or eliminated pain, numbness, and improved hand function after carpal tunnel release surgery, though some residual numbness may remain in severe cases.

What if I suspect I have carpal tunnel syndrome?
Seek an evaluation from a hand surgeon as soon as possible.