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Have you experienced tingling or numbness in your fingers or found it difficult to grip things as you usually would? If so, you could be experiencing the early symptoms of carpal tunnel syndrome. Tyler Atkins, MD, PPG – Neurosurgery, explains this complex condition.
What is carpal tunnel syndrome?
Carpal tunnel syndrome is the common phrase for entrapment neuropathy of the median nerve. In other words, it's a condition brought on by increased compression or pressure on the median nerve located in your wrist, causing discomfort and/or pain in your fingers, hand and arm.
What causes carpal tunnel syndrome?
In most cases, there is no specific cause for carpal tunnel syndrome. However, there are various jobs and activities that repeatedly place the wrist in a position of increased flexion or compression, which could contribute to the development of the condition. Some of those tasks can include, but are not limited to:
- Typing, texting or using a keyboard
- Various sports and physical activities
- Knitting, sewing, painting or writing
- Professions that require repetitive motion
- Heavy manual labor or construction work
- Use of power tools (regular or vibrating)
Some medical conditions could also place some people at an increased risk for carpal tunnel syndrome. Those can include, but are not limited to:
- Obesity
- Diabetes
- Hypothyroidism
- Rheumatoid arthritis
What are the symptoms of carpal tunnel syndrome?
Some of the most common signs and symptoms that accompany this condition include pain, tingling, numbness and swelling of the fingers and hand. Some have even described their discomfort or pain going up their forearm and into their shoulder.
Often carpal tunnel syndrome symptoms usually begin slowly, with most people only taking notice when the pain wakes them up in the middle of the night. Eventually, without treatment, the discomfort can spill into the daytime, often growing in intensity and occurrence.
Eventually, as a person's carpal tunnel syndrome worsens, their symptoms may become advanced and more persistent, resulting in pronounced hand weakness, dexterity issues and the inability to grasp things like normal.
How is carpal tunnel syndrome usually diagnosed?
The symptoms and when they occur are by far the most influential pieces of the diagnosis puzzle. There are physical exam findings that can help, but they aren't necessarily the most reliable in assessing that sensory deficit in those first three fingers.
Additionally, there are a couple of special tests where you try to elicit the symptoms by deliberately irritating the nerve. One is Tinel's sign, where the physician taps right over the median nerve at the wrist to see if it produces a tingling sensation in the fingers. The second is Phalen's test, where your provider will ask you to press the back of your hands and fingers together at 90 degrees of flexion with your fingers pointed down. You will hold this somewhat awkward position for roughly 30-60 seconds to see if symptoms appear.
Beyond the physical exam, if there's a question or a provider wants to confirm the diagnosis, they may also do an electrode diagnostic test or utilize various types of imaging if necessary. However, imaging isn't the mainstay for diagnosing carpal tunnel syndrome.
What are the different treatment options for the condition?
There are two main avenues for treating carpal tunnel syndrome: non-surgical and surgical. Typically, non-surgical treatments are for milder cases, allowing most people to resume their daily activities without interruption. Non-surgical options can include:
- Wearing a splint
- Taking anti-inflammatory medications
- Getting cortisone or steroid injections
- Discontinuing the repetitive action causing the condition
Surgical treatments are usually the last option and only recommended in more severe cases or when someone's symptoms do not respond or resolve with non-surgical treatments. However, when utilized, surgical treatments do prove beneficial and have positive outcomes.
At what point should someone seek medical intervention?
If someone's symptoms persist for a couple of weeks despite basic management (changing activities, over-the-counter pain medications or the use of a splint), then it's time to speak with your primary care provider. It's also reasonable to seek medical attention if you have a sensory change that lasts more than a few days or if you experience weakness at any time.
Moreover, if you experience weakness, you must be evaluated because the same symptoms, even in a broader sense, could be signs of something more severe. So, if you have transient tingling or weakness in your hand and it gets better, then yes, we're going to have a conversation about carpal tunnel syndrome, but those same symptoms could be a sign of stroke or something else altogether. So, if you don't understand why you have these symptoms, hopefully, it's something as benign as carpal tunnel, but either way, it's worth getting checked out.
