Carpal Tunnel Syndrome

The carpal tunnel is a space inside the wrist that can be seen as a tunnel from the forearm to the hand. It is surrounded by bone and a band of tissue called the transverse carpal ligament. The median nerve and nine tendons pass from the arm through the carpal tunnel and into the hand. Carpal tunnel syndrome occurs when there is an increase in pressure in this tunnel which compresses the median nerve. Numbness, tingling, pain and weakness in the thumb and index, middle and ring fingers can result.

Initially, carpal tunnel syndrome symptoms come and go and can be relieved by wearing a splint at night while sleeping. If pressure on the nerve continues, symptoms may intensify over time. To prevent permanent nerve damage and alleviate symptoms, surgery to take the pressure off the median nerve may be recommended.

Orthopaedic hand surgeons at Brigham and Women’s Hospital (BWH) are experts at diagnosing and treating carpal tunnel syndrome with a range of options, including non-surgical therapies and surgical approaches.

Causes

Although the majority of cases do not have an identified cause, Carpal tunnel syndrome may be affected by a number of factors, including:

• Health conditions such as diabetes, rheumatoid arthritis, and thyroid gland imbalance
• Heredity
• Pregnancy

Symptoms

Symptoms often come on gradually and mainly at night. They may get worse with activities such as driving, reading, typing or holding a phone. Symptoms can include:

• Tingling and numbness in the hand or wrist
• Pain that shoots up the arm or down to the fingers, sometimes leading to sleep disruption
• Dropping items
• Hand stiffness or cramping, especially in the morning
• Hand weakness and clumsiness
• Trouble making a fist

Diagnosis

Your orthopaedic surgeon will conduct a thorough examination and may need a variety of tests to determine if you have carpal tunnel syndrome:

• Medical history
• Physical examination including manipulating the wrist, hands and fingers to check for numbness, tingling, weakness and atrophy
• Electrophysiological tests
  • Nerve conduction studies
  • Electromyogram (EMG)
• Ultrasound

Treatment

Non-Surgical Treatment

If diagnosed early, symptoms of carpal tunnel syndrome may be reduced without surgery. Non-surgical treatments may include:

• Activity modification
• Anti-inflammatory medication
• Steroid injection
• Wrist splint or brace

Surgical Treatment

If non-surgical treatment does not relieve your symptoms, surgery may be recommended. Surgical approaches include:

• Carpal Tunnel Release An incision is made through the palm to relieve the compression on the median nerve.

Recovery

The length of recovery varies for each individual. If the nerve has been compressed for a long period, recovery may take longer. Movement of the fingers and wrists are encouraged following surgery to help prevent stiffness. Minor soreness in your palm may last for several weeks to several months.

Driving, activities of daily living and light lifting may be permitted soon after surgery. Your doctor will tell you when you can return to work and if you will have any restrictions.

Our certified hand therapists can help reduce swelling and speed your recovery through wound care, and strength and flexibility exercises.

Learn more about carpal tunnel syndrome - BWH Health Library

Learn more about carpal tunnel syndrome - American Academy of Orthopaedic Surgeons

Learn more about carpal tunnel syndrome – American Society for Surgery of the Hand