Treatment for Carpal Tunnel Syndrome

Dr. Andrew Foret, Hand and Wrist Specialist

It starts with mild tingling in your hand. Then numbness from time to time. It progresses and begins to interfere with your work. You have to pause and literally "shake it off." It gets worse, and you wake up in night after night with pain shooting up your wrist.

These are the classic symptoms of carpal tunnel syndrome, one of the most common causes of wrist and hand pain. Although most people think of the hands when they think of carpal tunnel pain, the condition can affect the wrist too, and actually starts there, when the median nerve, which is on the palm side of the hand, becomes compressed by other structures in the wrist.

The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but it is a classic overuse injury, occurring most often in those performing repetitive-type tasks in the manufacturing, construction, clerical, sewing, finishing and cleaning industries. Basically, anyone who often has their wrist situated at an awkward and repetitive angle for extended periods of time is vulnerable to the condition.

Carpal tunnel syndrome usually occurs only in adults, and women are three times more likely than men to develop carpal tunnel syndrome. This may be because the carpal tunnel itself is typically smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome may also be genetic, according to recent research.

If left untreated, pain from the condition becomes more severe, spreading up the arm and making it difficult to complete manual tasks, like typing or holding a hammer. This is why it is very important to pay attention to early warning signs – the tingling, numbness and mild pain or cramping – and seek an evaluation. If we can diagnose early, there are more options for non-surgical treatment, and we can hopefully avoid permanent damage of the median nerve, which can lead to loss of grip strength.

A diagnosis of carpal tunnel syndrome involves a physical examination of the hands, wrists, arms and shoulders, along with electrodiagnostic tests to measure the electrical activity of nerves and muscles.

Once a diagnosis is confirmed, non-surgical treatment options are always considered first. These include medication, injections, bracing and exercises to strengthen the muscles in the hand and wrist, just to name a few.

For some people, these measures can prevent, or at least delay, the need for surgery. If surgery is needed, an endoscopic carpal tunnel release procedure is performed in most cases. Endoscopic procedures have become commonplace thanks to today's technological advances. Using this technique for a procedure like carpal tunnel release means a shorter recovery time and an almost immediate reduction in the pain.