Carpal tunnel syndrome is a painful condition that affects the nerves in your wrist. It can make it hard to move your fingers and feel touch, pain, or temperature in one or more of them. While this condition is usually not a serious health threat, it can be very painful and limit your ability to do things you enjoy. If left untreated, carpal tunnel syndrome can also cause permanent nerve damage that affects your hand and wrist long after symptoms go away.
What is Carpal Tunnel Syndrome?
The carpal tunnel is a narrow tunnel or passageway in the wrist that holds important structures of the hand. It holds the nerves, blood vessels, and tendons that help control and coordinate hand movement.
Because the tunnel is a small space, it is particularly vulnerable to changes that make the space even smaller. Carpal tunnel syndrome occurs from compression of the median nerve within the tunnel. This nerve supplies sensation to much of the hand and controls the muscles of the thumb.
What are the Symptoms of Carpal Tunnel Syndrome?
Carpal tunnel can start with a sensation of pain or numbness in the hand. Other common symptoms include:
- Tingling in the hand and fingers. This sensation may travel up the arm into the shoulder and neck. Tingling may occur at night and be worse when you wake up in the morning.
- Pain or burning sensation that is relieved by shaking your hand, especially when it’s cold outside or after being outside in cool temperatures for long periods of time. This can happen because blood vessels are compressed within the tunnel by swelling tissue surrounding them.
- Numbness in part of your hand or fingers. The numbness may feel like wearing a glove that fits too tightly on one finger.
- Weakness in some fingers (especially those on the thumb side)
- Feeling pain in the wrist area during exertion, such as lifting weights or pushing heavy objects.
What Causes Carpal Tunnel Syndrome
Here are some of the primary causes of CTS:
Anatomical Factors: Some people have a smaller carpal tunnel or may have anatomical differences that change the space within the tunnel, making them more susceptible to CTS. Injuries such as wrist fractures or dislocations can also deform the space in the carpal tunnel, exerting pressure on the nerve.
Chronic Health Conditions: Certain chronic illnesses, like diabetes, rheumatoid arthritis, and hypothyroidism, can contribute to the development of CTS. These conditions can cause changes in body tissues or increase inflammation, leading to compression of the median nerve.
Repetitive Hand Movements: Activities that involve repetitive hand or wrist motions, especially if these motions are done under continual pressure or in awkward positions, can contribute to the swelling and compression in the carpal tunnel. Examples include typing, assembly line work, and the use of hand tools.
Extended Wrist Positions: Keeping the wrist in extended or flexed positions for prolonged periods, such as when holding a phone or using a keyboard, can increase pressure in the tunnel.
Hormonal Changes: Hormonal fluctuations, particularly during pregnancy or menopause, can cause changes in body fluids and swelling, impacting the carpal tunnel space.
Age and Gender: CTS is more common in older adults and is more frequently diagnosed in women. This may be due to hormonal factors or possibly smaller carpal tunnel dimensions in women.
Obesity: Being overweight can increase the risk of CTS, as excessive body weight can contribute to inflammation and pressure in the wrist area.
Who Gets Carpal Tunnel Syndrome?
Carpal tunnel syndrome is more common with:
Progressing age: As people grow older, the tissues within the carpal tunnel can degenerate or swell, leading to increased pressure on the median nerve.
Diabetes: Individuals with diabetes are at a higher risk of nerve damage, including damage to the median nerve. This is due in part to the high blood sugar levels associated with diabetes, which can lead to nerve compression.
Thyroid disease: Hypothyroidism, a condition where the thyroid gland is underactive, can lead to fluid retention, resulting in swelling that can compress the median nerve. Other thyroid conditions may also contribute to the development of CTS.
Pregnancy: During pregnancy, hormonal changes can lead to increased fluid retention and swelling in the body, including the wrists. This swelling can narrow the carpal tunnel and put pressure on the median nerve.
Inflammatory conditions: Conditions that cause inflammation in the body, such as rheumatoid arthritis, can lead to swelling in the wrist and compress the median nerve.
Possibly from activities: Activities that involve repeated flexing and extending of the wrist can increase pressure in the carpal tunnel. These activities might include typing, sewing, assembly line work, or playing musical instruments.
How is Carpal Tunnel Syndrome Diagnosed?
Diagnosing Carpal Tunnel Syndrome (CTS) involves a combination of medical history evaluation, physical examinations, and diagnostic tests. The process aims to confirm the presence of CTS and rule out other conditions that may have similar symptoms. Here’s a detailed look at how CTS is typically diagnosed:
Medical History Review: The diagnosis begins with a thorough review of the patient’s medical history. The doctor will ask about the symptoms, their duration, and any activities that may exacerbate the pain or numbness. Information about pre-existing health conditions, such as diabetes or arthritis, and any history of wrist injuries or conditions is also crucial.
Physical Examinations:
Wrist Examination: The doctor will examine the affected wrist for swelling, tenderness, or any physical abnormalities.
Tinel’s Sign Test: Gently tapping on the median nerve in the wrist to see if it causes tingling in the fingers.
Phalen’s Maneuver: The patient holds their forearms upright by pointing the fingers down and pressing the backs of the hands together. If numbness or tingling is felt in the fingers within 1-2 minutes, it may suggest CTS.
Hand Strength Test: Checking for weakness in the muscles around the base of the thumb.
Electrodiagnostic Tests:
- Nerve Conduction Studies (NCS): Electrodes are placed on the hand and wrist, and small electric shocks are applied to measure the speed of nerve signals.
- Electromyography (EMG): A thin-needle electrode inserted into muscles in the hand and arm measures the electrical activity in muscles.
- Ultrasound Imaging: This can visualize the size of the median nerve and may show swelling or other changes indicative of CTS.
- X-rays: Although X-rays can’t detect CTS, they may be used to rule out other conditions like arthritis or fractures that might be causing the symptoms.
- MRI Scans: While not typically used for diagnosing CTS, MRI scans can be helpful in complex cases or to rule out other issues.
- Blood Tests: Sometimes, blood tests are performed to check for conditions like diabetes, rheumatoid arthritis, or thyroid gland disorders that might contribute to CTS symptoms.
The process of diagnosing CTS is comprehensive, involving a mix of clinical evaluations and diagnostic tests. The goal is to ensure accurate diagnosis for appropriate treatment planning. Early diagnosis and treatment are crucial to prevent long-term damage and improve outcomes.
Treatments Options For Carpal Tunnel Syndrome at Avid Sports Medicine
At Avid Sports Medicine, we use an ultrasound to directly visualize the nerves in the hand, looking for changes in size that suggest carpal tunnel.
Treatment options focus on conservative and minimally invasive techniques that will be tailored to your own circumstances. This can include:
- Wrist splints
- Anti-inflammatory medications
- Therapeutic exercises
- Activity modifications
- Steroid injections
In some cases, to avoid or treat permanent changes in the nerve, surgical intervention may be required. If so, we can help to coordinate this step and assist with recovery.
Can Carpal Tunnel Syndrome Heal on Its Own?
In cases of mild CTS, particularly when linked to temporary conditions like pregnancy or minor strain, symptoms may improve naturally. This improvement is often seen after the underlying cause, such as fluid retention during pregnancy, is resolved. Furthermore, adopting self-care measures in the early stages, such as using wrist splints, making ergonomic adjustments, and modifying activities, can alleviate symptoms and potentially halt further progression of the condition.
The ability of CTS to heal naturally also hinges on the root cause of the syndrome. If CTS results from repetitive strain or poor ergonomic practices, making appropriate changes in these areas can lead to symptom improvement. However, when the cause is a chronic health condition like diabetes or rheumatoid arthritis, effectively managing the primary condition becomes essential for any improvement in CTS symptoms.
While the body has a natural capacity to repair minor nerve compression, this healing process can be slow and is not always guaranteed, especially if the pressure on the nerve continues or if the nerve damage is substantial. In more severe cases of CTS, where there is significant nerve compression or damage, the chances of the condition healing on its own are considerably lower. Prolonged compression of the nerve without adequate treatment can lead to permanent damage, including loss of sensation and weakening of hand muscles.
Therefore, while mild CTS might improve or even resolve on its own with proper self-care, it is important not to rely solely on natural healing. It’s vital to monitor the condition closely and seek medical advice if symptoms persist, worsen, or significantly interfere with daily activities.
When to See A Doctor
It’s important to know when to consult a healthcare professional about Carpal Tunnel Syndrome (CTS). Early intervention can prevent the progression of the condition and reduce the risk of long-term damage. Here are some key indicators that it’s time to see a doctor:
Persistent Numbness or Tingling: If you experience constant or intermittent numbness, tingling, or burning sensations in your fingers, particularly in the thumb, index, middle, or ring fingers, it’s a sign to seek medical advice.
Symptoms Affecting Daily Activities: When CTS symptoms start to interfere with daily activities, such as difficulty gripping objects, clumsiness, or a weakening grip, it’s crucial to consult a doctor.
Nighttime Symptoms: Many people with CTS experience worsening symptoms at night. If you find yourself waking up due to pain or numbness in your hand, it’s a clear indicator to see a healthcare provider.
Pain Extending Beyond the Wrist: If you experience pain extending from your wrist up your arm or down into your palm, this could signify CTS or another condition that requires medical attention.
Symptoms Persisting for Several Weeks: If your symptoms persist or worsen over several weeks, despite trying home remedies like rest, wrist splints, or over-the-counter pain relief, a doctor’s visit is warranted.
Lack of Improvement with Home Care: If you’ve tried ergonomic adjustments, rest, and other self-care measures without improvement, medical intervention may be necessary.
Weakness in the Hands: Experiencing a noticeable weakness in your hands or a tendency to drop things can be a sign of muscle damage from prolonged nerve compression, needing prompt medical attention.
If You’re at Risk: Individuals with diabetes, rheumatoid arthritis, or who are pregnant, and those with a family history of CTS should be more vigilant and consult a doctor early if symptoms appear.
What’s Next?
Schedule your free consultation to evaluate your individual circumstances. During this call you’ll speak directly with Dr. Jow, our sports medicine physician. While we can’t give out specific advice until you become a patient, we can discuss your issue and determine if Avid is the best fit for you. If an in-person visit is recommended, we will schedule it right away.