Carpal Tunnel Syndrome

shutterstock_114113611Symptoms

The most common symptom of carpal tunnel syndrome is numbness or tingling in the thumb, index and middle fingers. The numbness and tingling can be more pronounced during sleep, especially in the early morning hours. Fine-tuned movements of the thumb, index and middle fingers can become difficult. In severe cases, the muscles controlling the thumb become smaller and weak.

Causes

The most common cause of carpal tunnel syndrome is prolonged, repetitive movements of the wrist and hand, especially when the wrist is bent, such as with typing. Trauma from fractures, dislocations of the wrist, and injuries leading to scar tissue can also cause carpal tunnel syndrome; however, this is much less common than repetitive overuse. Pregnancy, hormonal imbalances, rheumatoid arthritis and diabetes can also cause wrist swelling, leading to carpal tunnel syndrome.

Background

The carpal tunnel is the area of the wrist between the eight bones of the wrist, known as the carpal bones, and the transverse carpal ligament, which lies on the palm side of the wrist connecting the outermost carpal bones forming a “tunnel.” Passing through the carpal tunnel is the median nerve, which provides sensation on the palm side of the thumb, index and middle fingers, along with sensation to half of the ring finger, and muscle strength to the thumb. Also passing through the carpal tunnel are tendons connecting the muscles of the forearm to the fingers. Carpal tunnel syndrome occurs when the median nerve passing through the carpal tunnel becomes compressed or irritated. This compression is most often caused by swelling of the median nerve, nearby tendons or both, secondary to excessive friction in the carpal tunnel.

Aligned Medical Group’s Approach

Treatment typically involves gentle, hands-on mobilization of the wrist bones to reduce pressure and restore mobility in the carpal tunnel. This is coupled with passive manual traction performed to ease swelling. Modalities, such as muscle stimulation, cold laser, ice or heat can speed up the healing time. Flexibility, exercise rehabilitation, and education regarding proper ergonomic use of your hands are important to stabilize your condition and minimize the chance of recurrence. For more stubborn cases, we inject anesthetics or steroids into the area to reduce pain and inflammation. Some patients benefit from splinting or bracing the wrist during activities involving repetitive use or during sleep. Oral anti-inflammatory medications can also help.