Carpal tunnel syndrome

Georgios Panagopoulos MD | Orthopaedic Surgeon

What is carpal tunnel syndrome?

Carpal tunnel syndrome is caused by increased pressure of the median nerve at the wrist. It is a very common condition that causes numbness, tingling and pain at the hand and wrist. The median nerve provides sensation to the thumb, index, and middle fingers, and to half of the ring finger. The small finger (the “pinky”) is typically not affected.

Who is at risk for carpal tunnel syndrome?

The median nerve, along with the other 2 peripheral nerves of the arm (the radial and the ulnar nerve) is responsible for sensation and motion of the fingers of the hand. Along its path, the median nerve passes through a narrow tunnel at the level of the wrist, called the carpal tunnel, defined by the carpal bones and the thick transverse ligament. This is where excessive pressure to the nerve can precipitate carpal tunnel syndrome.

Predisposing factors that may lead to carpal tunnel syndrome include:

• Hereditary factors (carpal tunnel can run in the family)
• Age
• Sex (women more susceptible)
• Pregnancy
• Wrist fractures
• Arthritis (rheumatoid, gout)
• Diabetes mellitus
• Thyroid disorders
• Alcohol

Workers at risk for carpal tunnel syndrome are those who do jobs that involve repetitive finger Repetitive activities in the workplace that include forceful or repetitive gripping or vibration can increase symptoms.

What are the symptoms of carpal tunnel syndrome?

The symptoms of carpal tunnel syndrome may include:

• Pain in the wrist, palm and fingers, often worse at night νυχτερινές ώρες (ο ασθενής ξυπνάει και νιώθει ανακούφιση με το τίναγμα των δακτύλων)
• Numbness & tingling, often worse at night, especially in the thumb, index & middle fingers
• Waking up at night, having to shake hand or hold over the side of the bed
• Fingers feeling fuzzy or swollen
• Dropping objects - clumsiness, weak pinch & grip
• Atrophy of the hand muscles, in severe cases

Symptoms usually start gradually, with frequent numbness or tingling in the fingers, especially the thumb, index and middle fingers. Some patients say their fingers feel useless and swollen. The symptoms often appear first during the night. The dominant hand is usually affected first and produces the most severe symptoms. Some people may wake up feeling the need to “shake out” the hand or wrist. Certain activities such as talking on the phone, reading a book or newspaper, or driving may exacerbate symptoms. Symptoms are initially intermittent but can become permanent, as severity of the condition increases. Hand weakness may make it difficult to perform fine manual tasks or grasp small objects. In chronic or untreated cases, the muscles at the base of the thumb may waste away (thenar atrophy).

Diagnosis

Early diagnosis and treatment are important to avoid permanent damage to the median nerve. The diagnosis of carpal tunnel syndrome is based in most cases on history and physical examination. When performing the physical exam, your Surgeon will perform sensation testing on your fingers and hand. They may also perform sensory testing of the forearm and arm because finding numbness outside the median nerve area may suggest a different problem. Your doctor may also perform clinical tests such as the Tinel’s test, Phalen’s and Durkan’s test. These tests are designed to increase pressure on the median nerve causing your symptoms to become more evident or worsen. Electrodiagnostic studies (EMG) may also be used to confirm the diagnosis or help differentiate from other conditions that might present with similar complaints, such as diabetic neuropathy or cervical radiculopathy. Ultrasound can also be used in the office to assess for abnormal median nerve diameter.

Non-surgical treatment

Non-surgical treatment options for carpal tunnel syndrome may include:

• Rest
• Stretching exercises.
• Wrist splinting, especially at night
• Activity modification, such as raising or lowering your chair, moving your computer keyboard or changing your hand/wrist position while doing activities in the workplace
• Physiotherapy/home exercise program
• Steroid injection in the carpal tunnel, under ultrasound guidance. This can also be diagnostic, in cases with atypical symptoms, or if diagnosis is unclear. 

Surgical treatment

Surgery - carpal tunnel release, is recommended when carpal tunnel syndrome does not respond to a trial of conservative management or has already become severe. The goal of surgery is to increase the size of the carpal tunnel in order to relieve the pressure on the median nerve. This is done by cutting (releasing) the ligament (transverse carpal ligament) that covers the carpal tunnel at the base of the palm. Surgery is usually performed under local anesthetic through a small incision at the wrist. Carpal tunnel release may also be performed endoscopically, in selected cases. Revision carpal tunnel surgery is typically a bit more elaborate (ie hypothenar fat flap), and is typically performed under general anaesthetic.

Please contact us for more information.

FAQs - Frequently Asked Questions