Affecting up to 10 million Americans, carpal tunnel syndrome (CTS) is one of the most common neurological disorders in the US. This condition causes debilitating pain and can impact all aspects of life, including work, social activities, and hobbies. While carpal tunnel release surgery may seem inevitable for many, NextPain Care offers a comprehensive 3-level approach as an alternative. This approach includes conservative care, medications, and advanced procedures. NextPain Care is dedicated to helping individuals manage their chronic pain with expertise. Discover how NextPain Care can help you regain control over your health.
What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a nerve condition that develops when the median nerve in the wrist is compressed, irritated, or damaged.
The median nerve, located outside of the brain and spinal cord, is responsible for controlling wrist movements and transmitting signals to the brain regarding muscle movements, sensations, temperature, touch, pain, and vibration.
The median nerve can become compressed when the carpal tunnel, a passageway composed of ligaments and tendons located in the wrist, becomes swollen, inflamed, or restricted. Given that this passageway is no more than 20 millimeters wide, even the slightest changes in anatomy can compress the median nerve that runs within it.
The narrowing of the carpal tunnel may be caused by a range of factors, including aging, injuries, repetitive hand motions, obesity, diabetes, inflammatory conditions like arthritis, thyroid disorders, and hormonal changes, such as those that occur during pregnancy or menopause.
When the median nerve is compressed, it may become irritated or inflamed, leading to pain, discomfort, swelling, and reduced range of motion. Pressure on this important nerve can also prevent nerve signals from reaching the brain, resulting in loss of feeling, numbness, and tingling in the hand.
Depending on the severity of this condition, carpal tunnel syndrome may cause disability, chronic pain, and even irreversible nerve damage.
To better understand carpal tunnel syndrome, let’s look at the anatomy and physiology of the wrist.
Anatomy and Physiology of the Wrist
The hand and wrist are at the core of most movements we perform every day; from driving, lifting a glass of water, and tying our shoes to working and enjoying our favorite hobbies. What makes all of these movements possible is the bundle of nerves, ligaments, tendons, and muscles in the wrist joint. Here’s what you need to know:
- A Little Bit About the Wrist: The wrist, also known as the radiocarpal joint, is a complex structure that links the forearm to the hand, stabilizes the hand, and allows the movement of our upper extremities.
- Anatomy of the Wrist: The wrist is a collection of several joints that connect the forearm bones (radius and ulna, also known as distal joints) to the carpal and metacarpal bones, which are the bones at the base of the hand and palm. These joints are made stable and mobile by several nerves and ligaments that connect the bones to one another, as well as to the hand and wrist muscles.
The carpal tunnel is located on the volar aspect of the wrist or the side of the palm. Small bones called carpal bones function as the floor and sides of the carpal tunnel, while the roof of the tunnel is made of a strong band of connective tissue known as the transverse carpal ligament.
- Functions of the Wrist: As a single joint, the wrist provides stability and range of motion to the hand and fingers. However, each component in the wrist and carpal tunnel has its own function. In particular, the median nerve, which is housed in the carpal tunnel, is responsible for controlling the movement and sensory capability of the base of the thumb, middle finger, index finger, and part of the ring finger.
Carpal Tunnel Syndrome Symptoms
CTS presents differently in each individual, showcasing a diverse array of symptoms. While some, like expectant mothers, experience CTS as a fleeting and minor issue, for others, it transforms into a persistent source of severe pain and disability.
- Pain in Hand and Wrist: A narrowing of the carpal tunnel can irritate and inflame the median nerve and surrounding structures, causing pain and discomfort. Initially, you may experience pain only on certain occasions, but as the condition becomes more severe, the painful sensations can become acute and constant. In people with CTS, the pain is often described as aching, with occasional burning and shock-like sensations. Over time, the pain may start to radiate from the wrist to the hand and fingers and intensify at night.
- Weakness in the Hand: The median nerve plays a role in controlling the movements of the hands and fingers, including pinching and gripping motions, and transmits nerve signals relating to the hand’s position within the surrounding space.When these motor signals are prevented from reaching the brain, you may experience weakness in the hand, loss of pinching strength, and clumsiness (e.g., dropping objects).
- Numbness and Tingling Sensation in the Fingers: Electric shock-like and tingling sensations, alongside numbness, are signs that the median nerve is unable to correctly send sensory and pain signals to the brain. These sensations are particularly noticeable in the part of the hand directly controlled by the median nerve, which includes the thumb and the index, middle, and ring fingers.
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What Causes This Condition?
In most cases, CTS is caused by a combination of factors. However, some causes and risk factors, such as repetitive stress to the hand and wrist, injury, underlying health conditions, and genetic factors, make it more likely. Let’s look at these factors in more detail below.
Repetitive Hand and Wrist Motions
Repetitive motions, especially when performed over long periods, may put the hand and wrist under excessive or constant pressure. High levels of stress can cause the ligaments and tendons in the carpal tunnel to become irritated, swollen, or inflamed, thus narrowing the passageway that houses the median nerve.
Individuals who are at greater risk of developing CTS include professionals who regularly use vibrating tools, work on an assembly line, or type on a keyboard. Athletes participating in sports that require prolonged hand movements, such as racket sports, archery, rock climbing, and handball, may also be prone to carpal tunnel syndrome.
Injury to the Wrist
Traumatic injuries that result in a dislocation or fracture of the wrist can lead to changes in the anatomy of the carpal tunnel and misalignments of the wrist joint. These changes can obstruct the carpal tunnel and irritate the median nerve.
Health Conditions
Some health conditions can lead to further inflammation and swelling of the carpal tunnel, constricting and damaging the median nerve. You may be at greater risk of developing CTS if you have one or more of the following diagnoses:
- Inflammatory Conditions: Inflammatory disorders such as arthritis, rheumatoid arthritis, and osteoarthritis cause the body to sustain high levels of inflammation for prolonged periods. Excessive inflammation leads to the breakdown and damage of the joint’s components and restricts the carpal tunnel due to fluid build-up and swelling.
- Type I and II Diabetes: Diabetes can cause spikes and drops in blood sugar levels, damaging the blood vessels that supply the median nerve with oxygen and nutrients. This results in the damage and death of nerve endings, interfering with normal nerve signaling. Controlling blood sugar can help manage this risk factor.
- Hypothyroidism: Some hormonal disorders, such as having an underactive thyroid, may lead to carpal tunnel syndrome. CTS is found in over 16% of people with hypothyroidism, possibly due to increased Body Mass Index and more severe fluid retention, which causes excessive stress and swelling in the wrist area.
Genetic Factors
Although carpal tunnel syndrome is not an inherited condition, the risk of developing this disorder is greater among those with a close relative diagnosed with CTS. Additionally, congenital conditions and malformations of the wrist that run in families, such as having a smaller carpal tunnel, can make carpal tunnel syndrome more likely.
Risk Factors
Some risk factors can increase your likelihood of developing carpal tunnel syndrome, including:
- Being Female: Females are three times more likely than men to suffer from CTS because women tend to have smaller wrist frames and narrower carpal tunnels. Hormonal changes during menopause and pregnancy can increase fluid retention and swelling, which may constrict the median nerve.
- Smoking: Smoking can damage the blood vessels that supply the median nerve with oxygen and nutrients, leading to nerve damage. Other substances that are neurotoxic include alcohol, lead, and arsenic.
- Being Overweight or Obese: Having a high Body Mass Index (BMI) can increase the build-up of fluids in the carpal tunnel, leading to swelling and compression of the median nerve. Extra weight may also add stress to the wrist structures. Obesity is a risk factor in several possible causes of carpal tunnel syndrome, including diabetes and arthritis.
- Anatomical Factors: Having a slight or small frame can also increase the risk of carpal tunnel syndrome.
Diagnosis and Evaluation
If you are experiencing pain, numbness, hand weakness, or tingling sensations in the wrist area, you may have carpal tunnel syndrome. A provider will perform one or more tests to offer an accurate diagnosis. These tests can include the following:
- Physical Examination: A specialist will begin with a review of your medical history and existing conditions. A healthcare provider will also ask about the nature and pattern of your symptoms to exclude other conditions. For example, if the tingling sensations and numbness occur in your little finger, which is unaffected by the median nerve, you may have a problem other than CTS. During a physical examination, a doctor will also press on the hand and wrist to determine the source of pain, assess your hand muscles’ strength, and test your ability to feel pressure in the fingers.
- Electromyography (EMG) and Nerve Conduction Studies (NCS): These tests are used to determine the ability of your median nerve to deliver sensory and motor signals to the brain. Using a thin-needle electrode or two electrodes (sticky pads) placed on the wrist, your doctor will apply mild electrical impulses.
As the mild shock navigates from the electrodes to the brain, your doctor will assess whether there are obstructions that cause it to slow down when passing through the median nerve. - Imaging Tests: Imaging tests such as X-rays, ultrasound, and magnetic resonance imaging (MRI) scans provide a visual representation of the inner aspect of the wrist. These tests are used to determine whether there are anatomical abnormalities, arthritis-related wear and tear, tumors, or physical obstructions in the carpal tunnel.
Conservative Treatment Options
Carpal tunnel syndrome is a condition that develops over time, and finding treatment as soon as possible can slow down the progression of pain and discomfort. If your discomfort is still mild, you can manage it by taking frequent breaks, avoiding activities that involve hand and wrist movements, and applying cold packs.
If carpal tunnel syndrome is related to the hormonal changes that occur during pregnancy, these conservative treatment options can help you manage your condition until it improves, which usually happens after delivery.
However, if the pain is becoming regular and more intense, you can discuss other treatment options, such as the ones below:
- Rest and Immobilization: Rest and immobilization can help reduce inflammation and swelling in the carpal tunnel area, which can decompress the median nerve. Nonetheless, the problem may return as soon as you resume your activities. An occupational therapist can help you modify your work and sporting activities to reduce the pressure on the wrist.
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), over-the-counter painkillers, and corticosteroid injections can help manage pain and inflammation in the short term or during flare-ups.
- Splinting: Using a splint can help you hold the wrist still when the pain from CTS intensifies, which usually happens at nighttime, while using your hands, or typing on a keyboard. This may be a recommended option for pregnant patients because splinting does not involve taking medications.
If carpal tunnel syndrome is caused by another underlying condition, such as diabetes or arthritis, treating these conditions may relieve the symptoms of CTS.
Conservative treatments are most effective when carpal tunnel syndrome is still mild or moderate. If you have constant pain, have been suffering from CTS for more than ten months, or experience numbness, you should look for more efficient treatment options. NextPain Care offers minimally invasive treatments to manage symptoms effectively and improve overall well-being.
Complications if Left Untreated
Leaving CTS unaddressed or not managing aggravating factors can lead to severe complications.
Firstly, constant pressure and constriction of the median nerve can cause irreversible nerve damage, leading to inhibited wrist function and disability.
Additionally, the pain and weakness you experience may make hand movement undesirable. If not exercised, the muscles of the hand, wrist, and fingers can shrink and lose mass. This condition, known as muscle atrophy, may require medical intervention to prevent irreversible damage.
Other complications of carpal tunnel syndrome include sleep disturbances. Eight in ten people with CTS experience sleep problems due to intensified wrist pain at night.
Moreover, over time, wrist pain and discomfort due to carpal tunnel syndrome can worsen, causing patients to lose an average of 27 days of work per year. About 18% of people who develop CTS are also forced to leave their jobs within 18 months of symptom onset.
If CTS does not improve with medications or is causing irreversible damage, surgery may become a necessary option. Let’s explore the surgical treatment options for carpal tunnel syndrome below.
Surgical Treatment Options
With nearly half a million carpal tunnel release surgeries performed each year in the US, carpal tunnel syndrome is one of the most common hand conditions requiring surgery.
However, surgical interventions for carpal tunnel release are recommended primarily for advanced cases of CTS or when conservative therapies have not delivered results.
If you are considering this treatment option, make sure to discuss the risks of carpal tunnel release surgeries with your healthcare professional. These risks include infections and potential irreversible damage to the median nerve.
Additionally, be aware of post-surgery recovery and rehabilitation times, which can extend to one year or more. If you require surgery on your dominant hand, the recovery process can significantly delay your return to work.
Here are some of the most common surgical interventions for carpal tunnel syndrome:
- Endoscopic Carpal Tunnel Release: This minimally invasive surgery is performed using a telescope-like instrument with an attached camera, known as an endoscope. The endoscope is inserted into the carpal tunnel through a small incision. It allows for a thorough examination of the carpal tunnel and enables the surgeon to cut a portion of the carpal ligament, creating more space for the median nerve.
- Open-Release Surgery: This procedure is more invasive and involves making an incision that runs from the palm of the hand to past the wrist. The surgeon cuts through the ligament to relieve pressure on the median nerve. Despite being more invasive, open-release surgery remains the most commonly performed procedure for carpal tunnel syndrome.
- Other Surgical Options: Other innovative and less invasive interventions include thread ultrasound-guided carpal tunnel release. This incision-less approach reduces the risk of damage to the median nerve and can be an effective alternative for some patients.
The NextPain Care Approach For This Condition
If you have moderate or severe carpal tunnel syndrome, you may be struggling with intense pain or even disability. The good news is, there are advances in medical therapy that allow you to manage your pain and regain control of your wrist’s function through multidisciplinary treatment methods.
NextPain Care aims to address all aspects and risk factors contributing to your pain by offering a treatment approach that is evidence-based and tailored to your specific situation. This unique 3-level approach includes conservative care, medications, and advanced procedures, ensuring comprehensive management of your condition.
Some of the therapies used as part of the approach include the following:
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Prevention of Carpal Tunnel Syndrome
Carpal tunnel syndrome can affect individuals of any age. While some risk factors such as genetics, a small frame, or menopause cannot be modified, others can be addressed to reduce your risk of developing CTS. Here are some key guidelines to follow:
- Proper Ergonomics: Working with a specialized lifestyle counselor and occupational health professional can help you understand how your everyday activities may negatively affect your wrist health. Implementing proper wrist ergonomics, maintaining better posture, and modifying activities can significantly reduce the risk of developing CTS.
- Stretching Exercises: Stretching and nerve gliding exercises can improve the strength and flexibility of your wrist structures, easing the pressure on the median nerve.
- Breaks and Rest Periods: If your job or sporting activity requires frequent use of your hands or wrists, prioritize breaks. Taking 10-15 minute rest periods every hour allows you to stretch your wrist and avoid excessive pressure on the carpal tunnel.
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