Carpal tunnel syndrome
Carpal tunnel syndrome is a progressively painful hand and arm condition that occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. A number of factors can contribute to carpal tunnel syndrome, including the anatomy of your wrist, certain underlying health problems and possibly patterns of hand use. Bound by bones and ligaments, the carpal tunnel is a narrow passageway — about as big around as your thumb — located on the palm side of your wrist. This tunnel protects a main nerve to your hand and nine tendons that bend your fingers. Compression of the nerve produces the numbness, pain and, eventually, hand weakness that characterize carpal tunnel syndrome.
Common carpal tunnel syndrome symptoms include:
- Tingling or numbness in your fingers or hand, especially your thumb and index, middle or ring fingers, but not your little finger. This sensation often occurs while holding a steering wheel, phone or newspaper or upon awakening. Many people "shake out" their hands to try to relieve their symptoms. As the disorder progresses, the numb feeling may become constant.
- Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on the palm side of your forearm
- A sense of weakness in your hands and a tendency to drop objects.
When to see a doctor
If you have persistent signs and symptoms suggestive of carpal tunnel syndrome, especially if they interfere with your normal activities and sleep patterns, see your doctor. If you leave the condition untreated, nerve and muscle damage can occur.
Carpal tunnel syndrome occurs as a result of compression of the median nerve. The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, with the exception of your little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function). In general, anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. For example, a wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis. In many cases, no single cause can be identified. It may be that a combination of risk factors contributes to the development of the condition
A number of factors have been associated with carpal tunnel syndrome. Although by themselves they don't cause carpal tunnel syndrome, they may increase your chances of developing or aggravating median nerve damage.
- Anatomic factors - A wrist fracture or dislocation that alters the space within the carpal tunnel can create extraneous pressure on the median nerve. Also, carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller than in men and there's less room for error. Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don't have the condition.
- Nerve-damaging conditions - Some chronic illnesses, such as diabetes and alcoholism, increase your risk of nerve damage, including damage to your median nerve.
- Inflammatory conditions. - Illnesses that are characterized by inflammation, such as rheumatoid arthritis or an infection, can affect the tendons in your wrist, exerting pressure on your median nerve.
- Alterations in the balance of body fluids - Certain conditions — such as pregnancy, menopause, obesity, thyroid disorders and kidney failure, among others — can affect the level of fluids in your body. Fluid retention — common during pregnancy, for example — may increase the pressure within your carpal tunnel, irritating the median nerve. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after the pregnancy is over.
- Workplace factors - It's possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve, or worsen existing nerve damage. But the scientific evidence is conflicting and these factors haven't been established as direct causes of carpal tunnel syndrome. There is little evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.
Tests and diagnosis
Your doctor may conduct one or more of the following tests to determine whether you have carpal tunnel syndrome:
- History of symptoms - The pattern of your signs and symptoms may offer clues to their cause. For example, since the median nerve doesn't provide sensation to your little finger, symptoms in that finger may indicate a problem other than carpal tunnel syndrome. Another clue is the timing of the symptoms. Typical times when you might experience symptoms due to carpal tunnel syndrome include while holding a phone or a newspaper, gripping a steering wheel, or waking up during the night.
- Physical exam - Your doctor will want to test the feeling in your fingers and the strength of the muscles in your hand, because these can be affected by carpal tunnel syndrome. Pressure on the median nerve at the wrist, produced by bending the wrist, tapping on the nerve or simply pressing on the nerve, can bring on the symptoms in many people.
- X-ray - Some doctors may recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture.
- Electromyogram - Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles your doctor wants to study. An instrument records the electrical activity in your muscle at rest and as you contract the muscle. This test can help determine if muscle damage has occurred.
Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel.
The electromyogram and nerve conduction study tests are also useful in checking for other conditions that might mimic carpal tunnel syndrome, such as a pinched nerve in your neck.
Dr. Berry’s Class IV Carpal Tunnel Program
The Class IV K-Laser is at the heart of our treatment program. It provides a safe, effective, non-invasive, painless solution for Carpal Tunnel conditions. Patients respond exceptionally well to treatments and usually notice significant pain relief after just a few treatments. Dr. Berry’s program utilizes the latest FDA Cleared Lasers, and combines them with other therapies to help reduce the pain, strengthen the muscles and increase range of motion. Most importantly these treatments help reduce inflammation/swelling, which helps improve overall function. Dr. Berry has been treating sports injuries for over 35 years and has been helping people suffering from various health conditions during that time. Patients seek his advice and care if they want to avoid surgery if at all possible and help you return to all the activities you enjoy.