Carpal Tunnel Syndrome
New York City

Carpal tunnel syndrome is a condition caused by compression of a nerve that supplies muscles and skin in the hand. A narrower than average passageway between the bones and ligaments of the wrist can place pressure on this nerve. Resulting symptoms include numbness, tingling, pain, and weakness on the palm side of the hand. The thumb, index and middle fingers are most commonly affected. Some individuals describe a feeling of tightness or swelling as well as sensations of hot or cold. Symptoms may come and go throughout the day, but are most pronounced while gripping an object. Many with carpal tunnel syndrome report being woken up by these symptoms. Vigorous shaking of the hand and wrist may provide temporary relief. Without treatment, the condition frequently becomes progressively worse, leading to permanent damage to the nerve and loss of muscle in the hand.

Causes

Anatomy varies from person to person as a result of inherited traits and hand use over time. These individual differences in the size and spaciousness of the carpal tunnel plays a major role in developing Carpal tunnel syndrome. This condition occurs more commonly in women, especially during or after pregnancy. Older people and and those with underlying diseases such as diabetes or arthritis are also at higher risk. Injury or repeated stress to the wrist may contribute to the development of this condition or increase the severity of existing symptoms, but whether they actually cause this syndrome remains unclear.

Diagnosis

There is no single, definitive test for carpal tunnel syndrome. Your physician will make a diagnosis based primarily on your symptoms and a physical examination. Pushing or tapping on specific sites or flexing and extending the wrist will often elicit pain and tingling if the condition is present. Electrical nerve tests and x-rays may also be used to confirm the diagnosis or to rule out other possible issues.

Treatments

Initial treatments focus on reducing discomfort without surgery. Non-steroidal anti-inflammatory medication such as ibuprofen can be taken for pain. There is some benefit to be gained from limiting activities which aggravate carpal tunnel syndrome. Wearing a splint at night to keep the wrist in a neutral position may also help. If these approaches do not provide adequate relief, a steroid injection into the wrist can reduce inflammation, although symptoms often return.

In more severe cases that do not respond to conservative treatment or involve loss of muscle in the hand, surgery is recommended. To perform this operation, a surgeon will release the transverse ligament, the structure that forms the roof of the carpal tunnel. Cutting this ligament decreases pressure on the nerve and increases the space around it. After the incision is closed, the skin and ligament will heal, creating more room for the nerve. Although there is some discomfort after surgery and a gradual recovery process of 2 months to a year, most patients experience significant long-term improvement of symptoms and report high levels of satisfaction. As with all surgery, there is some risk of infection or injury to the nerve.

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