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Carpal Tunnel Syndrome
Carpal tunnel syndrome is a condition brought on by a pinched median nerve at the wrist which sometimes causes numbness, tingling and pain in the arm, hand and fingers. The syndrome occurs when pressure builds up from the swelling in the carpal tunnel area, placing pressure on the nerve.
It is generally difficult to determine what causes the syndrome, though there are several possibilities. It can be triggered by swelling of the lining of a tendon (tenosynovitis), and is often associated with repetitive use of the hands. Bone dislocations, fractures and arthritis can also narrow the tunnel, but are usually not as common. Fluid retention during pregnancy can also be a temporary source of carpal tunnel syndrome. Medical conditions such as hypothyroidism, rheumatoid arthritis and diabetes can also trigger carpal tunnel syndrome.
Symptoms
 Pain, numbness, tingling (or a combination of the three) in one or both hands. (It generally occurs in the thumb, index, middle and ring fingers.)
Symptoms generally occur during the night but can be felt during daily activities such as driving or reading a newspaper.
Patients sometimes have a weaker grip and, as a result, may drop things.
In severe cases, sensation may be permanently lost and the muscles at the base of the thumb deteriorate (thenar atrophy).
Testing
Carpal tunnel syndrome is usually obvious from the pattern of symptoms in the hand, but electrical studies of the nerves and muscles may be conducted to confirm the diagnosis and determine whether the median nerve is compressed in any other areas (such as the shoulder or neck).
Treatment
Many times, carpal tunnel symptoms can be eliminated without surgery. Changing activities to reduce repetitive or strenuous use of the hand, or keeping the wrist in a straight position may help reduce the swelling, allowing more room for the nerve. Wearing wrist splints during the night may relieve the symptoms and allow for sleep. Anti-inflammatory medication or injections of corticosteroid drugs into the wrist may also help.
When symptoms are severe and do not improve, surgery to enlarge the carpal tunnel and decrease pressure on the nerve may be indicated. This is usually done on an outpatient basis with local or regional anesthesia. Following surgery, soreness around the incision may last for several weeks or months. The numbness and tingling may disappear quickly or slowly. It may also take several months for strength in the hand and wrist to return to normal. It is important to remember that returning to strenuous work after surgery can cause the symptoms to return.
Sentara's Hand Rehabilitation Program offers therapists who have received extensive training under the guidance of therapists, and who have been certified through the American Society for Hand Therapists. Certified hand therapy services are available at select outpatient centers within the Sentara Rehabilitation Network.
Research
Much of the current research is aimed at prevention and rehabilitation and is being conducted by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Prevention
Those involved in repetitive wrist activity (e.g., assembly line workers, keyboard operators) are most at risk for developing carpal tunnel syndrome. Investing in an ergonomically sound keyboard (or other equipment that can take the stress off the wrist, including splints) may help. And when the symptoms begin to present themselves, take a break from the activity until the symptoms have subsided.
Support Groups/Resources
Many patients and families find great comfort and support in talking with other patients, families and caregivers who have had (or are having) similar experiences. Support group meetings are free of charge, and are facilitated by a trained peer or qualified professional.
For more information or to find a support group nearest you, contact:
The National Institute of Neurological Disorders and Stroke
The National Institute of Arthritis and Musculoskeletal and Skin Diseases
The Sentara Rehabilitation Network - Hand Therapy Program
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