The carpal tunnel is a narrow structure in the wrist formed by the carpal bones and the carpal ligaments. This tunnel houses the median nerve and the flexor tendons. The median nerve travels from the forearm to the hand and is responsible for controlling feeling in the thumb and long fingers and controlling the muscles around the base of the thumb. The flexor tendons are responsible for bending the thumb and the fingers.
When the median nerve is pressed or squeezed at the wrist, numbness, pain and muscle weakness can occur in the hand and thumb. This condition is called carpal tunnel syndrome (CTS). According to the Mayo Clinic, for most cases, there are numerous causes of CTS and there are available treatments for symptom relief and restoration of normal use of the wrists and hands (Mayoclinic.com, “Carpal Tunnel Syndrome” accessed March 7, 2010).
Symptoms of Carpal Tunnel Syndrome
The symptoms of CTS usually begin gradually with discomfort in the hand. The discomfort may be described as tingling, pain or numbness in the thumb, index finger and in half of the ring finger. If the entire hand including the little finger is numb or in pain, this may be a sign of another problem. A different nerve gives feeling to the little finger so if this finger is spared of symptoms, it may be the telling sign of carpal tunnel syndrome (Webmd.com, “Pain management-carpal tunnel,” accessed March 7, 2010).
As the symptoms progress, it may feel like an electric shock going through the thumb, index finger or the long fingers. At first, symptoms may come and go and shaking the hands may relieve the symptoms. But, as the syndrome progresses, symptoms become constant.
A person with CTS may just think that they are clumsy or getting weaker. They may drop things more often, have difficulty grasping or may notice that their thumb is wasting away. Other symptoms may include strange sensations traveling up the arm toward the shoulder. The thumb side of the hand is where most people will feel the strongest symptoms.
Although symptoms can occur at any time, the strongest symptoms may be experienced at night time. Night symptoms are common and because some people sleep with their wrists curled, they may be awakened with sharp pain or they may wake up with numbness in their hand.
Daytime symptoms occur when the wrist is active as in turning the pages of a book while reading, holding the telephone, or while driving. It may become difficult to button clothing, tie shoelaces and other activities of daily living.
Factors that Contribute to CTS
When the carpal tunnel is narrowed, the median nerve is crowded. This narrowing can be due to swelling around the tunnel or by any factor that constricts the tunnel. Some illnesses can contribute to CTS as well as obesity, and hormonal changes as in pregnancy.
Hand use over time can play a role in the development of CTS. Making the same hand or wrist movements over and over, especially if the hand is lower than the wrist, is a common cause of CTS. Hand or wrist injuries and bone spurs can produce the type of swelling or narrowing seen in CTS.
Heredity, age and smoking are contributing factors. Small carpal tunnels can be a trait that is passed down in families. Older people are more at risk for developing CTS. Smoking reduces the blood flow to the medial nerve (Webmd.com, “Pain management-carpal tunnel,” accessed March 7, 2010).
Treatment Options for CTS
If the cause or contributing factor of CTS is identified early, some cases can be reversed by correcting the risk factor or by stopping the activity that is causing the symptoms. However, CTS usually progresses and symptoms become worse if there is no treatment intervention.
For many people, simple treatment measures may modify or stop early stages of CTS. One treatment may include supporting the wrist with a splint or brace. By keeping the wrist in a neutral position and allowing the swelling to resolve without further aggravation, the wrist can heal. Patterns of activity should then be changed or modified to prevent recurrence.
Medications are often recommended to ease the swelling, irritation and pain of CTS. Some medications include anti-inflammatory drugs and can be found over-the-counter or can be prescribed by a doctor. It is important to check with the doctor before trying to treat a condition with medication. A doctor may recommend an injection that can provide relief from the symptoms for short periods of time or ongoing injections to ward off progression of the syndrome.
In cases where non-surgical interventions have not been effective or in cases that are so severe that the symptoms interfere with one’s daily activities, surgical intervention may be required. In cases where there is wasting of the thumb muscles, surgery may be the option chosen so that irreversible damage is prevented. More information on surgical options can be found at orthoinfo.aaos.org, “Carpal Tunnel Syndrome”.
Mary Ann George - I am a registered nurse currently working as a case manager in the home health industry. My credentials include a BS degree in education, ...
