Many patients come to the Urgent or their primary care office with complaints of hand/wrist pain, numbness, tingling or a combination of these symptoms. They often wonder if it could be due to carpal tunnel syndrome.
Carpal Tunnel Syndrome: characterized by pain and numbness in the fingers and hands, and sometimes in the arms. It happens when the median nerve in the wrist becomes pinched or squeezed. The median nerve travels through a small “tunnel” in the wrist that is formed by bones and a ligament. It’s a setup for this nerve to become pinched due to our normal anatomy, but may be worse in some people or due to certain conditions. There is some thought that the nerve gets pinched possibly due to one or more of the following:
1) Tissues that surround the surrounding tends in the tunnel harden
2) Tendons that go through the tunnel get swollen
3) People hold their hands in a position that causes the tunnel to get smaller.
Parts of the hand affected by the median nerve:
2) Index finger
3) Middle finger
4) Half of the ring finger
5) The parts of the palm closest to the thumb
Symptoms: Pain, and tingling in the thumb, index, middle and ring fingers. These symptoms may be present in one or both hands. Rarely, the pain can travel up the wrist and forearm and even cause tingling past the elbow to the shoulder.
The symptoms are usually worse at night. Activities that may trigger carpal tunnel syndrome include:
4) Holding a phone
5) Sleeping at night – many people bend their wrist while sleeping
Testing: Nerve conduction studies or Electromyography can measure the speed of the electrical nerve conduction of the median nerve or show whether muscles of the hand and wrist are responding appropriately to the electrical signals. Most of the time the surgeons want these tests to be performed before they will consider surgical treatments for carpal tunnel syndrome.
Treatment: they are tailored to the individual patient and may include:
1) Wrist splints keep the hands in a neutral position, where the wrists are not bent forward to backward
2) Surgery is offered to patients who have severe symptoms and that involves cutting the ligament that stretches across the wrist to form the carpal tunnel.
3) Steroid shots or pills: The steroid medications that we use short-term are a group of medications that control inflammation and swelling. Sometimes we will inject a steroid directly into the carpal tunnel, but this is usually done by a hand specialist because of the risks of getting the steroid directly into the median nerve.
4) Osteopathic manipulation: There are techniques that an Osteopathic Physician (D.O.) may perform that can actually help increase the space inside the carpal tunnel ie. “carpal bone mobilization.”
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO