INTRODUCTION:

Carpal tunnel syndrome is a problem that affects the median nerve as it travels through the wrist area and into the hands to supply feeling to the fingers as well as muscle strength mostly of the thumb. Sometimes one hand is affected and sometimes both. Typically it starts with numbness or tingling of the fingers and especially the thumb, index, and middle fingers. Usually the pinkie is not involved.

SYMPTOMS
:

*Numbness and/or tingling of the fingers and hand
*Discomfort or aching of the hands
*Weakness of the hands
 
Often, people describe waking at night with discomfort. Many people have symptoms when they drive. If the conditon progresses there is loss of strength and people may drop cups or have trouble carrying packages or even with dressing or undressing.
 
Though it is commonly tied to computer/keyboard use, many people develop carpal tunnel in other ways. There can be an underlying genetic predisposition that is made worse with repetitive movement of the wrist and especially holding the wrist bent for prolonged periods of time. 
 
TESTING
 
Often a good history and exam will tell the story. If needed nerve testing (so-called EMG/NCV) can be done to confirm the diagnosis or the severity of the condition. This testing can also help in sorting out other conditions and especially neck involvement.
 
ASSOCIATED CONDITIONS

Many people with Carpal Tunnel Syndrome also have other problems with the hand and especially arthritis and various forms of trigger finger or tendonitis. The Carpal Tunnel can be part of a more generalized Repetitive Stress (RSI) problem that can end up affecting the whole arm to the neck.

Also, because the nerves that travel into the hand start way up in the neck it is important to make sure there are no associated problems there (so-called Cervical Radiculopathy) Other medical conditions such as diabetes and underactive thyroid can also influence the symptoms.
 
TREATMENT
 
Luckily the vast majority of cases can be treated quite simply and without surgery. One of the main components of treatment is using the hand and wrist in a smart way and so limiting added pressure on the nerve. A simple wrist splint will usually do the trick. There are other forms of non-surgical treatment such as Vitamin B6, massage and therapy, and cortisone injection that may be indicated depending on the specifics of the case.

Surgery is a last resort but happily it is usually a very straightforward out-patient procedure under local anesthesia with a high rate of success and a small,if any, scar. Many patients get almost immediate relief and are able to return to work sometimes within a few days, depending of course on the job. 
 
CARPAL TUNNEL DURING PREGNANCY

Occasionally symptoms of carpal tunnel syndrome may develop during pregnancy and especially during the last trimester(last three months). In some women it can become severe affecting their ability to function and sleep.

The treatment is largely the same as for carpal tunnel in other situations
i.e. avoidance of repetitive or prolonged wrist motion, especially flexion (bent). Of course, every effort is made to avoid use of medicines.

Another thing that can be helpful is massage and especially deep yet controlled massage in warm water twice a day for no more than 5 minutes each time, done right over the palm side of the wrist- that's where the nerve is getting compressed. Also, make sure you are not at war with your splint or brace. That is, let it set boundaries for you and don't fight it. It takes some getting used to like a new pair of shoes. And like shoes, make sure it feels comfortable- not too tight or too loose.

The good news is that the problem usually subides after delivery. In very severe cases you can speak with your doctor about cortisone injection around the nerve. While I'm not typically a big fan of this because it tends to be a short term solution, in the case of pregnancy induced carpal tunnel syndrome, you only need a short term solution ie to get through the last trimester.


If you have further questions please call us at 516-280-5844