Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Among adults, carpal tunnel syndrome is the most common form of nerve pain in the upper extremity (your upper arm, forearm, and hand). It is a progressive condition that can cause simple tasks such as holding your favorite coffee mug to become painful and difficult. To understand carpal tunnel syndrome, it helps to understand the structure of the carpal tunnel in your wrist, and the role played by the median nerve.

  • Think of the carpal tunnel as a narrow, rigid, non-stretchable passageway within the wrist that surrounds the median nerve.
  • The median nerve is a very important nerve responsible for the ability to feel sensation in all your fingers except the pinky. This nerve also contributes to your grip strength by controlling the muscles around the base of your thumb. The median nerve originates from your neck, travels down your arm and forearm, passes through your carpal tunnel, and finally enters your hand.

Carpal tunnel syndrome occurs when abnormal pressure is placed on the median nerve. If tissues surrounding the nerve are inflamed, or if the carpal tunnel itself narrows, the median nerve becomes irritated due to abnormal squeezing, pressing, and tightness in the wrist. The resulting symptoms —pain, numbness, tingling, and weakness in the hand —are known as carpal tunnel syndrome.

Symptoms of Carpal Tunnel Syndrome

Symptoms specific to carpal tunnel syndrome may include:

  • A feeling of swollen fingers, even if your fingers don’t look like it
  • Numbness, tingling, burning, and pain in the thumb, index, middle, and half of the ring finger
  • Shock-like sensations that radiate or travel from the wrist to the to the thumb and index, middle, and ring fingers
  • Pain or tingling that may travel from the wrist up the forearm
  • Weakness, clumsiness, and loss of sensation in the hand making simple tasks such as buttoning your clothes difficult to perform
  • Dropping items due to decreased grip strength.

Night-time symptoms are very common because it is natural to sleep with the wrists in a bent position. Many adults report needing to wake up in the middle of the night to shake out their wrist in order to relieve the pain, numbness, and tingling they feel.

What Causes Carpal Tunnel Syndrome?

Studies show that women and the elderly are more likely to develop carpal tunnel syndrome. While there is no one specific cause of the condition, a combination of multiple factors could lead to its development.

Risk Factors for Carpal Tunnel Syndrome:

  • Genetics: the size of the carpal tunnel may be smaller in some people.
  • Wrist positioning: activities involving prolonged flexion or extension of the wrist such as typing or holding a book can increase pressure on the median nerve.
  • Repetitive hand use: repeating the same hand and wrist motions or activities over prolonged periods may aggravate the nerve.
  • Power work equipment: using certain tools that cause your hands to vibrate can irritate the nerve.
  • Pregnancy: hormone changes during pregnancy can cause swelling within the carpal tunnel putting excess pressure on the nerve.
  • Medical conditions such as diabetes and thyroid imbalance are associated with carpal tunnel syndrome.

How to Test for Carpal Tunnel Syndrome:

An Electromyography (EMG) and Nerve Conduction Velocity (NCV) study may be recommended to determine the severity of compression across the wrist in the carpal tunnel, as well as to rule out other causes of nerve compression. The test is conducted by an EMG/NCV specialist such as a neurologist or physical medicine and rehabilitation physician.  Here at Seaview, your EMG and NCV tests may be conducted by pain management specialist Dr. Adam Meyers. The tests measure electrical activity of muscles and the speed of electrical signals traveling along the nerve across specific sites in the arm, including elbow and wrist. During the EMG, a small needle is inserted into specific muscles to measure and record electrical impulses within selected muscle fibers.

Treatment Options:

Carpal tunnel syndrome is a progressive condition that if left untreated can lead to permanent nerve damage. Patients affected by the condition report feelings of mental, emotional, and physical exhaustion from the growing pain and weakness in their upper extremity. For those experiencing symptoms, early diagnosis and treatment is essential for maintaining or improving their quality of life. The good news is that mild symptoms can often be relieved with simple measures such as wearing a wrist splint or avoiding certain activities.

A corticosteroid injection into the carpal tunnel can help relieve symptoms and may be a great option for patients unable to have surgery. However, because continued pressure on the median nerve can lead to nerve damage and worsening or persistent symptoms, a surgical procedure may be recommended to relieve the nerve.

What is Carpal Tunnel Surgery like?

Carpal tunnel surgery involves releasing the tight ligament surrounding the median nerve, which gets rid of the pressure on the nerve. This procedure improves blood flow allowing the nerve to heal. There are two ways to release the ligament: open surgical release or endoscopic surgical release. Open surgery releases the ligament from the outside in, while endoscopic surgery releases the ligament from inside out. During open surgical release, a small incision is made on the bottom of your palm. With endoscopic surgery, a smaller incision is made in your wrist crease. A small instrument is then passed into the carpal tunnel to release the ligament. Endoscopic surgery is known to allow the incision to heal with a less visible scar. You may experience soreness in your palm for about 3 months after surgery.

Post Carpal Tunnel Surgery Care & Recovery

The surgery is performed at a surgical center where you can go home the same day. Any pain experienced after the procedure is typically managed with alternating Tylenol and anti-inflammatory medications. Very rarely, will a stronger type of medication be necessary for managing pain after your procedure. A follow-up visit will be scheduled 10-14 days after surgery to have your sutures removed and the incision site checked by your physician. Physical or hand therapy is not necessary after carpal tunnel surgery.

After your first follow up appointment, you may begin slowly easing into  your normal daily activities according to your comfort levels. After 6-8 weeks, you may resume activities that require gripping, pulling and pinching. It can take up to 3 or more months to regain full strength, depending on the severity of your carpal tunnel syndrome. It is typical for the night time symptoms to improve first. Following your procedure, daily numbness and tingling can take several months to a year to improve. It should be noted that in severe cases, daily numbness and tingling may not completely recover. You will be advised on all your best options during your initial consultation.

If you are experiencing symptoms of carpal tunnel syndrome, use this link (insert scheduling link) to book a consultation with one of our expert Hand Specialists. We’re committed to exploring your best treatment options so you can get back to quality living!

Carpal Tunnel Syndrome Treatment in Central New Jersey and Jersey Shore 

At Seaview Orthopaedics, we offer a full range of treatment options for Carpal Tunnel Syndrome, including on-site physical therapy. Our hand, wrist, and elbow specialists, Dr. Joseph Gower, Dr. Monika Debkowska, Dr. Kevin McDaid, and Dr. Arthur Vasen are available for appointments at our six office locations. If you would like to Book Appointment, please call (732) 660-6200. We look forward to helping you!