At the base of your hand, there is a narrow passage of ligament and bone where the median nerve finds its way from your arm to the palm of your hand. The passage is your carpal tunnel, and when the nerve runs through it without difficulty, you don’t even think about it. But if the tunnel narrows due to inflammation or trauma, the nerve can be compressed, and the numbness, tingling and pain in your wrist, hand or fingers will let you know there’s a problem: carpal tunnel syndrome.
Genetics play a role in predisposing some people to this problem, and women are more likely than men to develop it. “Some of it has to do with the bones on one side and how small they are and how small the tunnel is, and some of it has to do with how thick the ligament gets on the top side,” says Dr. Crystel Knierim, an orthopedic surgeon with SSM Orthopedics. Carpal tunnel syndrome occurs when the nerve becomes irritated. This may happen because the ligament thickens and presses on the nerve, or “sometimes we get swelling around the flexor tendons that move our fingers up and down and run through the same canal our nerve does,” Knierim adds.
While some people assume that typing can cause carpal tunnel syndrome, Knierim says it can be an aggravating factor but usually not a root cause. Repetitive movements that put pressure on the wrist, such as repeated bending of the wrist joint, or swelling due to an injury, also can result in nerve compression. Assembly line workers are among the most common group afflicted with carpal tunnel syndrome.
“The most common symptoms of carpal tunnel are intermittent numbness and tingling in the thumb, index and long fingers,” says Dr. Charles Goldfarb, an orthopedic surgeon specializing in hand and upper extremity surgery with Washington University Physicians. The symptoms are noticeable during everyday activities, such as driving, talking on the phone or reading. Waking at night with your hand ‘asleep,’ and needing to shake or move it to regain normal sensation also is a classic complaint. As the condition worsens, some people complain of difficulty gripping objects or notice weakness in the thumb.
“Wearing a splint at night can help with sleep as it prevents the wrist from flexing during sleep and prevents the onset of numbness,” Goldfarb notes. Some patients can control the condition with antiinflammatory medications. Steroid injections also may help quell symptoms, although they are not considered a definitive cure. If conservative treatments don’t provide adequate relief, surgery to release the pressure on the nerve is the most effective treatment that offers a long-term solution.
“If the canal is released properly with surgery, there’s no reason to think that the problem is going to recur,” Knierim notes. “Occasionally, you’ll see people who have symptoms that arise after surgery, but it’s not always due to the same problem.” For instance, post-surgical tendonitis may mimic carpal tunnel syndrome, although this is not typical. Recovery from carpal tunnel surgery may take several weeks as swelling subsides and normal strength and function return.
The bottom line is that if symptoms are bothersome and persistent, you don’t need to suffer in silence, Goldfarb notes. “There are safe, effective treatments that can really help.”