What Is Carpal Tunnel Syndrome? Treatment, Symptoms, and Causes

Do you frequently experience numbness or tingling in your hand, especially at night? Perhaps you feel clumsiness when holding objects and sometimes sense pain radiating from your arm up to your shoulder. These could be symptoms of carpal tunnel syndrome. Orthopedics and Traumatology specialists at Yeditepe University Hospitals have answered frequently asked questions about carpal tunnel syndrome.

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome occurs when the median nerve becomes compressed as it passes through the carpal tunnel in your wrist. The median nerve runs from the forearm into your hand through a "tunnel" in your wrist. The floor and sides of this tunnel are formed by wrist bones, and the top of the tunnel is covered by a strong band of connective tissue called a ligament. This tunnel also contains nine tendons that connect muscles to bones and enable you to bend your fingers and thumb. These tendons are covered by a slippery membrane called the synovium, which can grow and swell in some cases. If the swelling is large enough, it can cause the median nerve to press against this strong ligament, leading to numbness, tingling in your hand, clumsiness, or pain.

What Causes Carpal Tunnel Syndrome?

Anything that causes the synovial membranes around the tendons in the carpal tunnel to swell, thicken, or become irritated can create pressure on the median nerve. Some common causes of carpal tunnel syndrome include:

• Repetitive and forceful gripping movements with the hands
• Repetitive bending motions at the wrist
• Fractured or dislocated bones that cause swelling in the wrist
• Arthritis, particularly rheumatoid arthritis
• Thyroid gland imbalance
• Diabetes
• Hormonal changes associated with menopause
• Pregnancy

Even if any of the above are present, in most cases there is no known cause.

How Is Carpal Tunnel Syndrome Diagnosed?

Diagnosis of carpal tunnel syndrome is made based on the following signs and findings:

• Symptoms such as numbness and tingling in the hands occurring at night and after using the hands
• Reduced sensation in the thumb, index finger, and middle finger
• A feeling of electric shock or tingling in your hand when your doctor lightly taps over the median nerve at the wrist
• Reproduction of your symptoms when your wrists are held in a downward-bent position for one minute

In some cases, your doctor may recommend a special test called a nerve conduction study. Performed by a specialist, this test determines the severity of pressure on the median nerve and can help your orthopedist confirm the diagnosis and establish a treatment plan.

How Is Carpal Tunnel Syndrome Treated?

In mild cases, treatment for carpal tunnel syndrome typically involves wearing a splint at night to prevent your wrist from bending.
Resting your wrist allows the swollen and inflamed synovial membranes to shrink, which reduces pressure on the nerve. The size of these swollen membranes can also be reduced with oral medications called nonsteroidal anti-inflammatory drugs. In more severe cases, your doctor may recommend a cortisone injection into the carpal tunnel. This medication spreads around the swollen synovial membranes surrounding the tendons and shrinks them, thereby reducing pressure on the median nerve. The cortisone dose is low and generally has no harmful side effects when used in this manner. The effectiveness of nonsurgical treatment often depends on early diagnosis and prompt intervention.

How Is Carpal Tunnel Syndrome Surgery Performed?

Surgery may be necessary for patients who do not benefit from nonsurgical measures. The surgical area is numbed with local anesthesia injected into the wrist, hand, or upper arm. This procedure can be performed by an orthopedist. During surgery, the ligament forming the roof of the carpal tunnel is cut to relieve pressure on the median nerve.
Your doctor will explain to you the reasons for recommending nonsurgical or surgical treatment based on your specific condition.

How Long Does Recovery Take After Carpal Tunnel Syndrome Surgery?

After carpal tunnel syndrome surgery, your symptoms may improve immediately or within a short time. Tenderness at the incision site may persist until healing is complete. Numbness may continue for a period, especially in older individuals or in more severe cases. Returning to your normal level of physical activity may take several weeks, and for some people, it may take several months. You will likely be asked to perform hand exercises to restore blood circulation, muscle strength, and joint flexibility in your hand and wrist.