Carpal Tunnel Syndrome: What You Need to Know

Carpal tunnel syndrome is one of the most common conditions affecting the hand and is highly responsive to treatment, says Dalibel Bravo, M.D., a board-certified, fellowship-trained orthopedic surgeon at Miami Orthopedics & Sports Medicine Institute. Dr. Bravo specializes in hand, wrist and elbow surgery.

Carpal tunnel syndrome is caused by pressure on the median nerve, which runs through a narrow passageway in your wrist (carpal tunnel) to your hand. The median nerve provides sensation to the palm side of your thumb and first four fingers and sends signals to move the muscles located at the base of your thumb.

Symptoms of carpal tunnel syndrome are tingling or numbness in your thumb and first four fingers and weakness of grip in your hand.

Dalibel Bravo, M.D., a board-certified, fellowship-trained orthopedic surgeon at Miami Orthopedics & Sports Medicine Institute.

“Many patients report that symptoms are worse with activities that increase pressure on the median nerve, such as holding a steering wheel; grasping vigorously; operating heavy or vibrating machinery; or sleeping with a fixed wrist posture that increases pressure on the median nerve,” Dr. Bravo explained.

Risk Factors

Carpal tunnel syndrome typically affects middle-aged to older individuals. It also strikes females three times more than males, possibly because the carpal tunnel area is smaller in women than in men.

Several factors may increase your risk of irritation to the median nerve and lead to carpal tunnel syndrome, including:

• Anatomic factors, such as a small carpal tunnel or changes due to a wrist fracture
• Rheumatoid arthritis, which can affect the lining around the tendons in your wrist and put pressure on your median nerve
• Diabetes, which increases your risk of nerve damage
• Hypothyroidism
• Obesity
• Workplace factors, such as working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of your wrist
• Pregnancy, which can lead to fluid retention that may temporarily increase pressure within your carpal tunnel

Diagnosis

To diagnose carpal tunnel syndrome, specialists like Dr. Bravo will review your pattern of symptoms and conduct a clinical evaluation that may include:  

• Observation of atrophy of the thenar muscles, which are located at base of your thumb on the palm side of your hand
• Sensory testing to reveal decreased sensation to light touch and two-point discrimination in your median nerve
• Motor testing to reveal weakness of opposition through resistive muscle testing and palpitation of your thenar muscles
• Provocative testing, which involves recreating symptoms of pain by putting pressure on your median nerve
• Electrodiagnostic testing such as nerve conduction velocity and electromyography, which are used to confirm a diagnosis when other tests and symptoms indicate carpal tunnel syndrome

Prevention

The most effective way to prevent carpal tunnel syndrome is to control contributing diseases, Dr. Bravo explains. This means controlling sugar levels with diabetes, managing inflammation with rheumatoid arthritis and correcting hypothyroidism. It also may be beneficial to avoid continual strenuous grasping and extreme wrist positions by alternating tasks, taking frequent breaks and gently stretching and bending your hands. This is especially important if you use equipment that vibrates or requires great exertion.

Treatment

The treatment goal for this condition is to decrease pressure in your carpal tunnel and improve the blood flow and nourishment to your median nerve. Nonsurgical treatments such as nighttime neutral wrist splinting and cortisone injections are more likely to help if you have mild to moderate symptoms. Nighttime wrist splinting can provide a daily period of improved blood flow to your nerve. Cortisone injection into your carpal tunnel can decrease inflammation and swelling and relieve pressure on your median nerve.

On the other hand, if your symptoms are severe, you should consider surgery to prevent progression and further nerve damage, says Dr. Bravo. Surgical treatment increases the space available for the median nerve by releasing the ligament. Surgical methods include open release, endoscopic directed release and minimal incision release. Dr. Bravo often performs these surgeries using a technique known as wide-awake local anesthesia, which eliminates the need for lab work and medical clearance and minimizes the risk of general anesthesia.

“Although patients may experience soreness or weakness for several weeks after surgery, the long-term outcome is excellent for all three surgical techniques, with success and patient satisfaction rates over 90 percent,” Dr. Bravo said.