Orthopedics

Carpal tunnel syndrome—causes and cures

Wrist pain

If your fingers feel numb, burn or tingle after repetitive motion or certain positions, you may be experiencing carpal tunnel syndrome. This condition can develop when inflammation inside your wrist compresses your nerve. You may also have weakness of grip or tingling that travels up your forearm.

“Many people feel this for the first time at night because their wrist is bent when they sleep, which increases the pressure in the carpal tunnel” says James C. Kyriakedes, M.D., a Riverside orthopedic hand surgeon. “The symptoms initially come and go, but may eventually become constant.”

What causes carpal tunnel syndrome?

The nerve involved in carpal tunnel syndrome is called the median nerve. It runs into your hand through a tunnel in the wrist surrounded by your carpal (wrist) bones and a thick band of connective tissue — the transverse carpal ligament. The median nerve typically provides feeling in all of your fingers except for the pinkie.

“The reality is that there is no direct cause of this condition, just contributing factors. Repetitive movement of your hand or wrist can cause inflammation in the tissue, increasing the pressure in the tunnel, and thereby decreasing the blood flow reaching the median nerve,” Dr. Kyriakedes says.

Any repetitive activities, such as fishing, cleaning, carpentry, working on an assembly line, cashiering and using vibrating power tools regularly can contribute to carpal tunnel syndrome.

Other factors that can contribute to developing carpal tunnel syndrome include:

  • Anatomy – Some people have a narrower tunnel.
  • Diabetes – Many people with diabetes experience nerve problems.
  • Gender – Women are more likely to be diagnosed than men.
  • Hand and wrist position – Extreme flexion or extension of the hand and wrist for a prolonged period can increase pressure in the tunnel.
  • Pregnancy and menopause – Hormonal changes can increase pressure on the nerve.
  • Rheumatoid arthritis – This and other inflammatory conditions can swell the tissue around the tendons in your wrist.

Carpal tunnel syndrome treatment

“If we diagnose carpal tunnel in its early stages, we can often treat it nonsurgically,” Dr. Kyriakedes says. “Since the condition gets worse gradually, it’s important to see your health care provider as soon as you suspect you might have carpal tunnel.”

At-home treatments

You can take many steps at home to reduce symptoms and even reverse the course of this condition, by decreasing the pressure on your median nerve:

  • Brace or splint your wrist. Wearing one at night will keep your wrist from bending while you sleep.
  • Don’t sleep on your wrists
  • Take a break from doing activities that make you feel worse. If you experience the symptoms at work, try to modify your work area to avoid prolonged wrist flexion and vibratory equipment.
  • Take nonsteroidal anti-inflammatory medicine, such as ibuprofen (Advil or Motrin) or naproxen (Aleve).
  • Use a warm or cold compress

Nonsurgical medical solutions

  • Exercises – Exercises that help the median nerve move more freely within the carpal tunnel may help.
  • Steroid injections – Injecting corticosteroid, a strong anti-inflammatory medication, into the carpal tunnel can reduce inflammation.

Surgical solutions for carpal tunnel syndrome

If these measures don’t decrease your symptoms, surgery is a cure for this condition. By cutting the transverse carpal ligament on the roof of the tunnel, more space is created, which allows blood flow to return to the nerve.

Dr. Kyriakedes performs a minimally invasive surgery called the “mini-open” carpal tunnel release. This technique allows patients to immediately use their hands for light activities, and resume more strenuous activities as tolerated between 1-2 weeks later.

cartoon carpal tunnel surgery plan

Read more about hand and wrist treatments at Riverside Health System.

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