Carpal Tunnel Syndrome (CTS)

Burning, numbness or pain in the wrist and hand

Carpal Tunnel Syndrome (CTS) is often seen in people whose work or hobbies result in repetitive motions of the wrist and hand, including musicians, hair stylists, assembly line workers (especially those who operate vibrating tools) and those who use keyboards. The result can be burning, numbness or pain in the wrist and hand that can ultimately lead to decreased gripping strength and coordination.

How Does Carpal Tunnel Sydrome Develop?

The median nerve runs the length of the arm and provides feeling to the palm side of the thumb and fingers (except for the pinky). This nerve and a series of tendons run through a narrow channel in the wrist called the carpal tunnel. If the tendons become irritated and swollen, the tunnel can get smaller and press or squeeze on the median nerve.

Those with smaller bone structures may be more susceptible to CTS, which is why the condition is seen more frequently in women than in men. Obesity is also a significant risk factor for developing CTS.

Symptoms

-Numbness, weakness or pain in the hand, including decreased grip strength.
-A loss of strength and coordination, especially the ability to use your thumb to pinch.
-Burning, tingling or itching of the index and middle fingers.
-A sense of the hand “falling asleep” at night and awakening to a pins-and-needles sensation.
-A worsening of symptoms as the day progresses, perhaps while engaged in activities like driving, holding a phone or reading a paper.

Diagnosis

After taking a full medical history, we will examine your hands, arms, shoulders and neck. We will look for tenderness, swelling, warmth and assess the strength you have in the wrists and fingers. We may also order imaging tests (to look for things like a fracture, arthritis, a cyst or tumor) and lab tests to rule out underlying conditions, such as diabetes, hypothyroidism and rheumatoid arthritis.

We may also conduct specific hand and wrist manipulation tests to see if we can recreate your symptoms. Other options include a nerve conduction study to measure electrical activity of the nerves and muscles in your wrist or electromyography to determine the extent of the damage to the median nerve

Treating Carpal Tunnel Syndrome

Like most conditions, CTS is best treated early for greater success. We will begin with conservative measures such as:

-Splinting to stabilize movement in the wrist.
-Lifestyle changes, including efforts to reduce or eliminate repetitive movements, or at least incorporating designated rest periods into the day. Improved posture and form can help, too.
-Ice to reduce swelling.
-Exercises to strengthen and stretch the tendons that may be causing the nerve irritation.
-Reducing pain and discomfort with over-the-counter anti-inflammatories medications.

If these efforts do not result in relief, we can inject prescription corticosteroid or lidocaine medications into the wrist to relieve pressure on the median nerve. If that fails, open or endoscopic surgery can be performed under local anesthesia to sever the ligament around the wrist and relieve pressure on the nerve. After surgery, the ligaments usually fuse back together and open up the space in the carpel tunnel to relieve pressure on the nerve.