What is Carpal Tunnel Syndrome? Symptoms, Causes and 6 More Things to Know

Carpal tunnel syndrome is a condition caused when a nerve in the hand and wrist becomes compressed due to pressure on the median nerve. 

Nine tendons and the median nerve travel through the carpal tunnel, a small space inside your wrist. The median nerve is the softest structure within the carpal tunnel. Anything that increases swelling and pressure within the tunnel can cause pressure on the median nerve. This pressure, or compression, leads to the symptoms of carpal tunnel syndrome. 

Increased pressure can be due to arthritis, infection, bone spurs, cysts, injury, fracture or repetitive movement. Although carpal tunnel syndrome can affect just about anyone, it more commonly affects women. It is more common as you get older.

What are the symptoms of carpal tunnel syndrome?

Carpal tunnel syndrome symptoms often develop gradually. They commonly include:

• Numbness or tingling in the thumb, index and middle fingers, typically on the palm side of the hand
• Fingers that feel weak, swollen or both
• Tingling sensations during activities like holding a phone, driving or reading a book
• Weakness in the hand, making it difficult to grasp small objects
• Loss of sensation in severe cases, which may impair the ability to distinguish between hot and cold, potentially causing burns
• The urge to shake the hand, often at night or upon waking

Symptoms are typically felt in the thumb, index finger, middle finger and ring finger, and they often affect the dominant hand first and more severely. Both hands can be impacted over time.

Holding the wrist in certain positions can worsen the symptoms of carpal tunnel syndrome. Symptoms can worsen at night, partially due to sleeping position. People sometimes wake up with their hands feeling numb and tingly, sometimes requiring them to be shaken out for relief. 

Sometimes, symptoms can become so severe that they never really improve and become constant. Weakness and loss of muscle tissue in the hand and thumb can develop. 

What causes carpal tunnel syndrome?

Carpal tunnel syndrome can be caused by repetitive hand motions or prolonged strain on the wrists. Common contributing factors include:

• Extended use of smartphones for scrolling or texting
• Prolonged computer mouse usage
• Poor posture while working at a computer
• Spending long hours playing video games
• Repetitive tasks like sewing, cleaning, assembly line work or data entry

How is carpal tunnel syndrome diagnosed?

Carpal tunnel syndrome can usually be diagnosed based on clinical history and a physical exam, though sometimes electrodiagnostic studies (EMG) are necessary for confirmation.

Is carpal tunnel painful?

Carpal tunnel syndrome typically begins with mild symptoms that can be easy to overlook. Early signs include occasional tingling, numbness or weakness in the thumb, index and middle fingers. Without treatment, these symptoms may get worse, or become more frequent and severe. Over time, you might experience persistent pain and difficulty performing hand-related tasks.

Daily activities such as typing, writing or holding objects may become increasingly challenging. Many individuals may avoid certain activities or overuse their non-dominant hand, leading to additional issues.

What helps carpal tunnel?

You should seek medical attention right away if you notice persistent numbness or tingling in the thumb, index and middle fingers, or if you experience hand weakness. Additional concerning signs include loss of grip strength or pain radiating up the arm, especially when it disrupts daily activities.

There are many non-surgical treatment options for patients with carpal tunnel syndrome. These can include with simple activity modifications, avoiding activities that cause symptoms and taking anti-inflammatory medications. Tips include:

1. Exercise regularly: Focus on exercises like wrist flexor and extensor stretches to relieve tension and improve mobility.
2. Take breaks: Incorporate frequent breaks during repetitive tasks to rest your hands and wrists.
3. Use wrist splints: Wearing splints, especially at night, can help keep your wrists in a neutral position and reduce pressure on the median nerve. Make sure the splint fits properly and offers adequate support.
4. Adjust workspace ergonomics: Changes like proper desk and chair height, optimal keyboard positioning and ergonomic accessories can prevent symptom exacerbation.

Additional treatments can include occupational therapy, steroid injections or wearing a splint at night. The splint holds the wrist in a more natural position and decreases the pressure within the carpal tunnel. 

If your carpal tunnel doesn't improve with these non-surgical treatments, make an appointment with your doctor.

When does carpal tunnel require surgery?

In cases that don’t respond to non-surgical treatment, your doctor might recommend a standard surgical procedure known as carpal tunnel release.

In this procedure, a ligament is divided to give the carpal tunnel more space, relieving pressure on the compressed median nerve. This can be done through traditional open surgery or a less invasive surgical option known as an endoscopic carpal tunnel release.

With an endoscopic carpal tunnel release, a small incision about a centimeter in length is made near the wrist. A tiny camera is inserted into the carpal tunnel and the ligament is divided. It is an outpatient surgery, and patients go home the same day. The surgery takes approximately 15 minutes.

If left untreated, carpal tunnel syndrome can cause permanent nerve damage, resulting in chronic pain, muscle atrophy and reduced hand functionality. 

What should you expect after carpal tunnel surgery?

Patients often recover more quickly and return to work sooner with an endoscopic carpal tunnel release than the more traditional open release. The incision is smaller and is located further away from the ligament, leading to less pain, less scarring and quicker recovery.

After surgery, you will have two stitches and a soft dressing on the hand. This helps protect the incision until it is healed.

How to prevent carpal tunnel syndrome

• Take frequent breaks to stretch hands and fingers
• Perform conditioning exercises before and after tasks
• Use an ergonomic mouse and keyboard
• Keep your keyboard at elbow height
• Wear braces to keep wrists in a neutral position while sleeping
• Avoid continuously bending or extending your wrists

Recognizing the symptoms of carpal tunnel syndrome and getting treatment early can prevent long-term complications.