Carpal Tunnel Syndrome

The carpal tunnel is a passageway through the wrist carrying tendons and one of the hand's major nerves known as the median nerve. Pressure may build up within the tunnel because of disease such as rheumatoid arthritis, injury and fluid retention during pregnancy or menopause. Carpal tunnel syndrome develops when the pressure causes a tingling sensation in the hand, often accompanied by numbness, aching and impaired hand function.

Symptoms

Symptoms of carpal tunnel syndrome can affect one or both wrists and are frequently only experienced during the night in the early stages of the condition. Symptoms generally begin with the following sensations which are focused in the middle and index fingers as well as the thumb:

  • Burning
  • Itching
  • Numbness
  • Tingling

These sensations do not usually affect the pinky finger and generally come and go at first before becoming more constant as the condition progresses. Some patients may also experience the sensation of swollen fingers even though there is no evidence of this visible.

Diagnosis

Diagnosis of carpal tunnel syndrome usually begins with a physical exam and a review of the patient’s medical history and symptoms. Commonly used diagnostic tools include electromyography and nerve conduction studies, which can provide insight into how the nerve is working through analyzing the electrical activity of the muscles as well as the speed of that activity.

Other diagnostic tools such as magnetic resonance imaging, x-rays and CT scans are often used to determine the extent and cause of the condition such as an injury or inflammation.

Treatments

There are surgical and non-surgical treatments for carpal tunnel syndrome. Non-surgical treatment options focus on splinting and medication. Splinting consists of wearing a wrist splint and possibly cortisone injections. Splints can improve the condition by holding the wrist in a natural position. Night and occupational (job-specific) splints specially crafted by occupational therapists to fit the individual's hand keep the wrist in a neutral position, reducing pressure on the median nerve. Other helpful strategies include altering sleep position and avoiding extreme flexion and extension of the wrist.

In special circumstances, various medications can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Oral diuretics can decrease swelling.

Corticosteroids (e.g., prednisone or lidocaine) injected directly into the wrist or in pill form, can relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. People with diabetes and those who may be predisposed to diabetes should note that use of corticosteroids could make regulating insulin levels difficult. Corticosteroids should not be taken without a doctor's prescription.

Some studies also suggest that vitamin B6 supplements may ease the symptoms of carpal tunnel syndrome.

For some patients, surgical treatment may be the best option. Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms are present for six months, surgery involves a two-inch incision in the wrist and cutting the carpal ligament to enlarge the carpal tunnel, reducing pressure on the median nerve. Surgery is performed under local anesthesia and does not require an overnight hospital stay. The scar gradually fades and becomes barely visible.

The results of the surgery depend in part on how long the condition has existed and how much damage has been done to the nerve. For that reason, patients should see a doctor early if they think they may have carpal tunnel syndrome.

The Center for Plastic and Reconstructive Surgery and the Cedars-Sinai Department of Neurosurgery offers surgical procedures for carpal tunnel syndrome. Surgeons use leading-edge technology and world-class surgical techniques and will work with each patient to determine the best treatment option.