Carpal Tunnel Syndrome

Understanding the Symptoms, Causes and Treatments

Understanding Carpal Tunnel Syndrome

The wrist is a joint with multiple bones, tendons, and nerves that connects the arm to the hand. There are multiple nerves that go to the hand, one of which is the median nerve. This nerve is commonly compressed in the carpal tunnel, causing pain, numbness, and weakness in the hand.

Causes of Carpal Tunnel Syndrome

Carpal tunnel can occur for a variety of reasons:

Decreased space in the carpal tunnel, impinging on the nerve (for many reasons)
Repetitive griping and use of the muscles that go through the wrist.
Wrist dislocation, fracture, or other injury
Significant wrist arthritis
Certain systemic diseases affecting nerves

Symptoms of Carpal Tunnel Syndrome

Pain and tenderness over the wrist.
Numbness and tingling in the thumb, pointer, and middle finger
Weakness with your grip
Atrophy in certain hand muscles

Diagnosing Carpal Tunnel Syndrome

A comprehensive history and physical examination is the most important piece to determine if the median nerve is involved in your wrist pain. Electrodiagnostic studies (EMG/NCS) look at the health and quality of your nerves. It can determine how severely the nerve may be damaged and at what location your nerve symptoms originate. Ultrasound is used to visualize the nerve and determine if there is any injury or swelling within the nerve.

Treatment Options

Optimizing your ergonomics to reduce stress on the nerve
Bracing may be needed to help of-load the nerve and prevent the wrist from bending to reduce nerve compression and facilitate healing
Physical therapy – To help reduce stress on the nerve. Nerve glides are exercises your therapist can teach you to try and reduce nerve irritation.
Medications– Usually NSAIDs or neuropathic pain medicines are used to help with pain and nerve irritability.
Steroid injections- Strong anti-inflammatory medications to reduce pain and inflammation. Typically done with ultrasound to guide the injection around the nerve.
Surgery- In rare circumstances, your doctor may refer you to a specialist to decompress the nerve if symptoms are very severe or non-responsive to conservative treatment.