Carpal Tunnel Syndrome

What is carpal tunnel syndrome? with Dr. Steven Goldberg

Anatomy
The carpal tunnel is located at the base of the hand. It is formed by several small bones of the wrist and connective tissue forming a tunnel. The median nerve runs through this tunnel and provides important sensory input to touch. It additionally stimulates several muscles of our hand through a series of branches that extend primarily to the thumb, index, and middle finger.

Causes
There are several factors that contribute to the causes of carpal tunnel syndrome. Symptoms originate from compression of the median nerve within the carpal tunnel. Everyday activities at work or at home that are repetitive and require a tight grip may increase irritation or compression of the nerve. Holding a position for an extended amount of time and pervious wrist injuries may also contribute to symptoms. Additional risk factors include an individual's gender and anatomy.

Symptoms
Common symptoms include numbness and tingling of the thumb, index, and middle finger. Numbness and tingling typically increases with activity and can worsen over the course of the day, impacting sleep. Coordination of the hand and fingers may also be affected as changes in sensation occur. A decrease to grip strength may result of muscles in the hand becoming weak due to compression of the median nerve.

Diagnosis
An individual may see their primary provider or an orthopedic specialist for physical examination and review of activity performance and symptoms. A diagnostic test called an EMG is currently used to further delineate the diagnosis and severity of carpal tunnel syndrome.

Treatment
Carpal tunnel syndrome can be treated both conservatively and surgically depending on severity. Conservative treatment typically involves occupational therapists who specialize in rehabilitation of the hand and upper extremity. Rehabilitation may include provision of a regular home exercise program, instruction in activity modification, and use of additional treatment methods. Steroid injections and anti-inflammatories may additionally be utilized by the physician.

Surgery
Conservative approaches may not be appropriate for some patients depending on findings from the initial exam and/or EMG. Surgery known as a carpal tunnel release is typically performed by an orthopedic surgeon. A small incision is made at the base of the wrist to the connective tissue forming the carpal tunnel. This relieves pressure of the median nerve with the purpose of relieving compression of the median nerve and associated symptoms.

Recovery
This procedure typically allows for minimal downtime without need for further treatment or therapy. Depending on the severity of symptoms prior to surgery, individual factors, and work requirements occupational therapy may additionally be ordered to assist with return to everyday activities.

Prevention
Several techniques can be utilized for prevention of carpal tunnel syndrome. Recognizing risk factors or activities that recreate symptoms early on is key. Modifying home or work spaces to assist with the positioning of the hand/wrist for optimal performance, and avoiding repetitive tasks or activities that require a tight grip typically help prevent or alleviate compression of the median nerve. Customized home exercise programs and identification of activities that increase symptoms can be beneficial for the long-term prevention of carpal tunnel syndrome.