Carpal Tunnel Symptoms and Treatment

Carpal tunnel is a common, yet often misunderstood, orthopedic condition that affects millions of people around the world. It's not just an ailment suffered by office workers or those who type frequently; it can affect anyone, from musicians to factory workers, and even athletes. Let’s dive deep into the world of carpal tunnel syndrome (CTS) to demystify its causes, symptoms, diagnosis, and treatment options.

What is carpal tunnel syndrome?

Carpal tunnel syndrome, or CTS, is a condition that occurs when the median nerve, which runs from your forearm into your hand, becomes compressed within the carpal tunnel—a narrow passageway located on the palm side of your wrist. This compression can lead to various uncomfortable and sometimes debilitating symptoms, often requiring medical intervention to alleviate.

Carpal tunnel causes

To understand carpal tunnel syndrome, one must first grasp the basic anatomy of the wrist. The carpal tunnel is a narrow, rigid passageway formed by the bones and ligaments in the wrist. Within this tunnel, there's precious little room for maneuver. When any of the structures within it become swollen or irritated, it can compress the median nerve, giving rise to carpal tunnel syndrome.

There are several factors that can contribute to the development of CTS.

• Repetitive hand movements: Prolonged and repetitive hand and wrist movements, such as typing, assembly line work, or playing musical instruments, can lead to irritation and swelling within the carpal tunnel.
• Hormonal changes: Some hormonal changes, like those during pregnancy or menopause, can increase the risk of CTS.
• Anatomical factors: Wrist fractures, dislocations, or congenital conditions that result in a narrower carpal tunnel can also be causative factors.
• Medical conditions: Conditions such as diabetes, rheumatoid arthritis, and hypothyroidism have been associated with a higher risk of CTS.

Carpal tunnel symptoms

Identifying carpal tunnel is crucial for timely intervention. The following are five common symptoms:

• Patients often experience tingling or numbness in the thumb, index, and middle fingers. This numbness can radiate up the arm.
• A weakening grip or difficulty holding objects can be indicative of CTS.
• Many sufferers describe pain in the hand or wrist, sometimes extending up the forearm.
• A burning sensation may be felt in the hand or fingers.
• Symptoms are often more pronounced at night and may even wake you up from sleep.

How is carpal tunnel diagnosed?

Carpal tunnel syndrome is typically diagnosed through a combination of medical history evaluation, a physical examination, and sometimes specialized tests. 

Your orthopedic specialist will begin by asking you about your symptoms, including when they started, their duration, and any factors that exacerbate or alleviate them. They may also inquire about your occupation and daily activities to assess potential risk factors.

A thorough physical examination is essential in the diagnostic process. During this examination, your orthopedic specialist will assess the strength, sensation, and mobility of your hand, wrist, and fingers. They may also look for signs of swelling, tenderness, or deformities in the affected wrist.

Once a comprehensive evaluation is completed, your orthopedic specialist will make a diagnosis based on the combination of your medical history, physical examination findings, and any relevant test results. Early diagnosis and intervention are key to managing carpal tunnel syndrome effectively, so don't hesitate to seek medical attention if you suspect you may be experiencing CTS symptoms.

Carpal tunnel test

A carpal tunnel test is a medical evaluation or examination used to help diagnose carpal tunnel syndrome. These tests are typically performed by healthcare professionals to assess the symptoms and signs associated with CTS and to determine the severity of the condition. There are several tests and maneuvers commonly used to diagnose carpal tunnel syndrome.

Tinel's sign

The Tinel's sign test involves gently tapping the median nerve at the wrist to see if it triggers a tingling or shock-like sensation in the fingers. A positive Tinel's sign is often an indicator of CTS.

Phalen's test

In the Phalen's test, you'll be asked to flex your wrists by pressing the backs of your hands together for about a minute. If this position reproduces your CTS symptoms, it can be another sign of the condition.

Electrodiagnostic tests

In cases where the diagnosis is not clear from the physical examination, your healthcare provider may recommend electrodiagnostic tests. These tests, which include nerve conduction studies and electromyography, measure the electrical activity of the median nerve and the muscles controlled by that nerve. They can confirm the presence and severity of nerve compression.

Imaging studies

Although less common, imaging studies like ultrasound or magnetic resonance imaging (MRI) can help rule out other conditions that might be causing your symptoms, such as wrist tumors or cysts.

Blood tests

In some cases, blood tests may be ordered to check for underlying medical conditions like diabetes or thyroid disorders, which can contribute to CTS.

How to prevent carpal tunnel

Preventing carpal tunnel syndrome involves a combination of good practices:

• Maintain proper ergonomics in your workspace.
• Take frequent breaks to stretch and rest your hands.
• Engage in wrist-strengthening exercises.

Carpal tunnel treatment

The choice of treatment depends on the severity of your symptoms. For mild cases, conservative approaches are often the initial recommendation. 

Carpal tunnel brace

Wearing a wrist brace can help stabilize the wrist and alleviate pressure on the median nerve.

Ergonomic changes

Adjusting your workspace or equipment to reduce strain on the wrist.

Carpal tunnel exercises

Physical therapy exercises can improve wrist strength and flexibility. Check out the exercises we prepared below.

Carpal tunnel surgery

If conservative methods don't provide relief, carpal tunnel surgery, also known as carpal tunnel release, may be necessary. This procedure involves cutting the ligament that forms the top of the carpal tunnel to create more space for the median nerve. It's a highly effective treatment option for those with severe or long-lasting symptoms.

Carpal tunnel exercises

Carpal tunnel exercises can help alleviate symptoms and strengthen the muscles in your wrist and hand. These exercises are often recommended as part of conservative, non-surgical treatment for carpal tunnel syndrome. Remember to consult with an orthopedic specialist or physical therapist before starting any exercise regimen, as they can provide guidance specific to your condition. 

Wrist flexor stretch

• Extend your arm with the palm facing up.
• Use your other hand to gently bend your wrist downward.
• Hold the stretch for 15–30 seconds.
• Repeat on both wrists.

Wrist extensor stretch

• Extend your arm with the palm facing down.
• Use your other hand to gently bend your wrist upward.
• Hold the stretch for 15–30 seconds.
• Repeat on both wrists.

Wrist tendon gliding 

• Begin with your hand in a neutral position.
• Gently flex your wrist, then make a fist.
• Slowly extend your wrist, and finally, stretch your fingers wide.
• Perform this sequence several times.

Wrist flexor and extensor strengthening

• Use a lightweight dumbbell or a resistance band.
• Sit with your forearm resting on a table, palm facing up.
• With the weight in hand, flex your wrist upward, then slowly lower it.
• For wrist extensors, turn your forearm over, palm facing down, and lift the weight by extending your wrist, then lower it.
• Start with a light weight and gradually increase as your strength improves.

Finger tapping

• Place your hand on a table or a flat surface with your fingers spread.
• Tap each finger against the surface, one at a time.
• This exercise helps improve finger dexterity and coordination.

Isometric exercises

• Press your palms together in a prayer position.
• Apply gentle pressure for 5–10 seconds.
• Release and repeat.
• You can also use a soft stress ball to perform isometric exercises.

Median nerve gliding

• Extend your arm and gently bend your wrist, so your fingers point toward the ceiling.
• Slowly bend your wrist downward, then turn your hand outward, so your fingers point to the side.
• Lastly, turn your hand upward and flex your wrist.
• Perform this sequence several times to encourage the gliding of the median nerve.

Wrist circles

Gently rotate your wrist in circles in both clockwise and counterclockwise directions. This exercise helps improve joint mobility and blood flow.

Consistency is key when performing carpal tunnel exercises. Aim to do them regularly, but avoid overexertion or any movement that exacerbates your symptoms. If your symptoms persist or worsen, consult with an orthopedic specialist for further guidance and potential additional treatment options.

Discuss carpal tunnel treatment with the best orthopedic surgeons on PreferredMD

Carpal tunnel syndrome can be a frustrating and sometimes painful condition, but with timely diagnosis and appropriate treatment, relief is within reach. Remember, the road to recovery often starts with understanding the symptoms and seeking help from an orthopedic specialist. By taking proactive steps and following the advice of medical professionals, you can regain control of your grip and restore the quality of your life.