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Carpal Tunnel Syndrome – Causes, Diagnosis, Treatments

Dr. Daniel Osei analyzing patient

People commonly associate the development of carpal tunnel syndrome with longstanding computer use. In reality, typing on a keyboard is rarely if ever the “cause” of carpal tunnel syndrome. Moreover, almost anyone can develop the condition. In fact, as many as one in 20 Americans will experience it during their lifetime.

What Causes this Condition?

It’s often difficult to pinpoint a specific cause. However, as we get older, we’re more susceptible to experiencing the pain, numbness, tingling and weakness in our hands and fingers that characterize carpal tunnel syndrome.

The condition arises from too much pressure on the median nerve, which travels from the forearm to the palm through a narrow passageway in the wrist known as the carpel tunnel. It usually affects the thumb, index, middle finger and ring finger. Sometimes the pain travels up the arm to the elbow or even to the shoulder, and many people experience symptoms in both hands.

Importance of Timely Diagnosis

If left untreated, carpal tunnel tends to get worse and can be functionally debilitating as time goes on. I advise people to see a physician if they have more than one episode of severe pain, numbness and tingling or start to notice milder symptoms on a consistent basis.

There’s an increased risk of developing carpal tunnel syndrome following a wrist or hand injury or other medical condition that causes pressure on the median nerve. People who have diabetes, an underactive thyroid, rheumatoid arthritis or a very small wrist are also at greater risk.

Frequent use of a computer keyboard, manual labor and other repetitive activities using one’s hands can make the condition and the associated symptoms worse. Texting doesn’t cause it, but can exacerbate symptoms in susceptible individuals.

To diagnose carpal tunnel, the physician takes a detailed medical history and performs a physical exam. Sometimes tests that measure the electrical activity of the nerves and muscles assist in the diagnosis. Other conditions such as arthritis or nerve compression in the neck need to be ruled out.

In many patients, carpal tunnel syndrome is detected early on. Significant pain keeps them up at night, and they have difficultly driving and engaging in other activities. They generally see a physician in a timely manner to seek relief.

Treatments for Carpal Tunnel Syndrome

Conservative treatments for carpal tunnel focus on alleviating symptoms and may include:

  • Activity modification to decrease wrist motion
  • Wearing a splint to keep the wrist straight while the patient sleeps or works on a computer
  • Anti-inflammatory medication, such as ibuprofen
  • A steroid injection, which may provide relief for 3 to 12 months, or sometimes longer
  • Medications that decrease nerve-specific pain (eg. gabapentin or pregabalin)
  • Physical therapy

When conservative treatments fail to help patients, they may decide to have surgery. A common outpatient procedure, it entails removing the “roof” of the carpal tunnel to make more space and relieve pressure on the nerve. This is achieved by cutting a ligament in the wrist through a one-inch incision. The procedure takes about 30 minutes and is performed under local anesthesia.

At Hospital for Special Surgery, we see a high level of patient satisfaction. The pain is improved almost immediately after surgery and symptom relief is expected to be long-lasting.

When Carpal Tunnel Syndrome Goes Undiagnosed

It’s not uncommon to see patients who have had subtle pressure on their median nerve for decades, but the symptoms weren’t severe enough for them seek medical advice. The challenge is that by the time they see a physician, the condition may have affected the pinching muscles along the base of their thumb or caused a loss of sensation, particularly in the thumb, index finger and middle finger.

Over time, pressure on the median nerve causes muscles at the base of the thumb to waste away. This in turn causes weakness, leading to a loss of grip strength. Symptoms of advanced carpal tunnel syndrome:

  • Patients feel clumsy and start dropping things
  • Patients feel weaker and report decreased grip or pinch strength
  • Their handwriting has gotten worse
  • They’re no longer able to button a shirt
  • They have trouble picking up coins or a glass of water

People generally don’t notice that their hand looks different due to muscle loss (atrophy) until the physician points it out to them. Once an individual starts losing grip strength, surgery is usually considered so the damage and disability don’t get worse. Without treatment, normal activities of daily living can become increasingly difficult as the nerve and muscles deteriorate further. The ability to bathe, get dressed and use utensils may be affected, and quality of life will suffer.  As a patient advocate, I encourage treatment to prevent someone’s condition from getting worse.

For these patients, surgery will relieve the pain, although the loss of sensation and numbness in their fingers will likely take some time to get better. Importantly, it will prevent carpal tunnel syndrome from causing additional damage.

As in most illnesses and medical conditions, timely diagnosis and treatment are recommended for the best outcome.

Daniel Osei, MD, is a hand surgeon specializing in carpal tunnel syndrome and microvascular surgery at HSS.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.