Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed or “pinched” as it passes through the carpal tunnel in the wrist, causing such symptoms as pain, grip weakness, and numbness and tingling in the fingers.
The median nerve is a sensory nerve that runs the length of your arm, going through a passage in your wrist called the carpal tunnel, and ending in the hand. It provides sensory and motor (movement) functions to your thumb and first 3 fingers.
Carpal tunnel syndrome usually occurs in adults, and women are diagnosed with this condition 3 times more often than men.
While many cases of CTS have no specific cause, it is often linked to wrist anatomy, certain health problems, and the use of heavy or vibrating equipment such as a jackhammer. Repetitive hand motions such as typing sometimes contribute to carpal tunnel syndrome as they put excessive and frequent pressure on your median nerve, but research suggests this is not as common as once thought.
Why Choose Cooper to Diagnose and Treat Carpal Tunnel Syndrome
Cooper University Health Care has a team of four fellowship-trained and board-certified or -eligible hand surgeons with extensive experience in diagnosing and treating carpal tunnel syndrome. You can count on us for:
- State-of-the-art diagnostic resources: Cooper is one of the few centers in the region to offer advanced musculoskeletal ultrasound (MSK-US), a much less-invasive technique than electromyogram (EMG) for diagnosing carpal tunnel syndrome
- Personalized treatment: Treatment is tailored to the severity of your condition and your overall health, and may include splinting, medication, and physical therapy. In more advanced cases, surgery is done to ease pressure from the median nerve.
- Leading-edge research: Cooper’s hand surgeons are involved in academic research on carpal tunnel syndrome, ensuring that our patients benefit from the latest knowledge and treatment advances
Causes of Carpal Tunnel Syndrome
Carpal tunnel syndrome is caused when there is pressure on the median nerve. Anything that compresses or irritates this nerve inside the carpal tunnel space may lead to CTS. In many cases, there is no single, specific cause; any of these factors—alone or in combination—may contribute to or increase the risk of getting CTS:
- A wrist fracture, sprain or dislocation
- Rheumatoid arthritis, osteoarthritis and other inflammatory conditions
- Gender— carpal tunnel syndrome is more common in women, perhaps because the carpal tunnel area tends to be smaller
- Diabetes and other nerve-damaging conditions
- Frequent gripping hand motions in physical activities such as sports
- Frequent exertion of wrist and fingers, such as playing piano, guitar, and various other musical instruments
- Hormonal or metabolic changes (for example, menopause, pregnancy, or thyroid imbalance)
- Workplace factors—Frequent, repetitive movements of the hand and wrist (such as with working at a keyboard or on an assembly line), or working with vibrating equipment may be factors in some cases.
- Scientific evidence isn’t conclusive, however.
- Family history of CTS
Symptoms of Carpal Tunnel Syndrome
The most common symptoms of carpal tunnel syndrome, which can affect one or both hands, include:
- Weakness when gripping objects
- Pain or numbness
- Pins-and-needles feeling in the fingers, especially the thumb, index and middle fingers
- Swollen feeling in the fingers
- Worsening of symptoms at night, interrupting sleep
Left untreated, carpal tunnel syndrome can cause permanent damage to the median nerve, so it is important to see a specialist for an accurate diagnosis and appropriate treatment as soon as symptoms appear. It is also important to see a specialist because the symptoms of carpal tunnel syndrome may be similar to other conditions such as arthritis, a pinched nerve in the neck, or neuropathy (which can be a complication of diabetes).
Diagnosing Carpal Tunnel Syndrome
If you are experiencing any common symptoms and align with any of the causes of carpal tunnel syndrome, you should schedule an appointment with a hand specialist to receive a proper diagnosis.
The diagnostic experience begins with a conversation with one of our specialists at the Hand and Nerve Center. You will discuss your symptoms and whether your lifestyle and family history may suggest you could have carpal tunnel syndrome.
If an initial discussion ends with a sense that you may have the condition, you will undergo a physical examination of the hand, wrist, and forearm. This will include feeling the different muscles along your hand and arm, measuring the strength level and different sensations of the patient. Specific movements and actions will be done to monitor the appearance of any noteworthy symptoms.
If a physical examination gives any indication that you may have CTS, then more advanced diagnostic procedures will be done, including:
- Ultrasound: An ultrasound will provide a thorough image of the nerves and bones in the affected area, which will lead to a visual confirmation of a compressed median nerve.
- X-Ray: An x-ray is not necessarily helpful in diagnosing CTS, but it is a useful means of ensuring the symptoms are not due to any kind of unrelated hand injury or arthritis.
- Electromyography: An electromyography identifies affected muscles through electrical activity tracked by electrodes placed on your hand and forearm. This will determine the activity of the median nerve and pinpoint any signs of compression.
Treating Carpal Tunnel Syndrome
Your treatment plan will be determined through an ongoing conversation with your doctor. They will assess the many different factors specific to your condition, including your age, your overall health and the breadth and severity of symptoms.
If your doctor determines that the symptoms are not especially severe and your overall health and medical history indicate a promising recovery, then your treatment plan may include:
- Splinting to keep your wrist from moving and ease nerve compression
- Anti-inflammatory medication that may be oral or injected into the carpal tunnel to reduce swelling
- Hand therapy that includes stretching and strengthening exercises supervised by our certified hand therapist
If your doctor determines that the symptoms are severe and the condition is not likely to improve with the methods listed above, then surgery may be the best option for you. The objective or carpal tunnel surgery is to release the ligament that is placing pressure on the median nerve. Cooper’s hand surgeons perform two types of carpal tunnel release surgery:
- Open surgery: The surgeon makes an incision on your wrist to access the carpal tunnel, and cuts the tissue that is pressing on the nerve
- Endoscopic surgery: With this minimally invasive approach, the surgeon inserts a thin rod (scope) through a tiny cut on the wrist; the scope contains a camera and light that enable the surgeon to see inside your wrist and release the compressed nerve using tiny surgical tools
Preventing Carpal Tunnel Syndrome
Because so many factors can contribute to carpal tunnel syndrome, there’s no single, proven way to prevent it. But there are strategies that can lessen stress on your hands and wrists:
- Take breaks: Stretch and bend your wrists and hands regularly—forward and backward—and alternate tasks whenever possible, especially if you use vibrating equipment or tools that require you to use a lot of force
- Relax your grip: If you work at a keyboard, hit the keys softly. If you write by hand, use a large pen with an oversized grip adapter.
- Regularly perform hand and wrist exercises: A certified hand therapist can provide guidance on stretching and strengthening exercises; even 5 minutes daily can help
- Mind your form: Use your keyboard at elbow height or slightly lower. Avoid bending your wrist all the way up or down; a relaxed position in the middle is best. Consider wearing a wrist splint to keep your wrist in the correct position.
- Maintain good posture: Poor posture causes your shoulders to roll forward, shortening your neck and shoulder muscles and compressing nerves in your neck. This, in turn, can affect your wrists, fingers and hands.
- Keep your hands warm: A cold environment increases the risk of developing hand pain and stiffness. If you can’t turn up the heat, wear fingerless gloves to keep hands and wrists warm.