Have you ever awakened at night to a “dead” hand and fingers? Did you have to literally “shake the life” back into it? Do you find yourself dropping things, feeling clumsy?
If you answered yes to one or more of these questions, you may well be experiencing the condition known as carpal tunnel syndrome.
Carpal tunnel syndrome is a condition that arises from pressure being exerted on the nerve that passes from the forearm into the hand, through an area of the wrist know as the carpal tunnel. This tunnel is a passageway made up of the bones of the hand below the nerve, and the transverse carpal ligament from above, thus creating this “tunnel.”
The nerve in question is called the median nerve. It serves the duties of detecting sensation, together with initiating muscle movements of the thumb, index finger and long finger. In addition to the nerve, several tendons also pass through this tunnel, making for a bit of a congested situation to begin with.
This pressure can be caused by injury (such as a wrist fracture) or, as is more often the case, repetitive activity and overuse. Nerves and tendons swell, and the transverse carpal ligament becomes thick, putting the “squeeze” on the nerve, especially with grasping activities (like holding pencils/pens, hammers and coffee cups, right?) Occasionally, pregnant women experience carpal tunnel syndrome that is pregnancy-induced and usually goes away after delivery. As pressure is exerted on the nerve, it begins to lose some of its ability to function, thus causing numbness and tingling in the thumb, index and long fingers of the affected hand as well as causing muscle wasting around the thumb in the more severe cases. The longer the nerve stays pinched, the higher the risk of permanent damage.
Symptoms can range from the very mild - patchy numbness at the tips of the affected fingers - to the severe, where there is frank numbness and loss of muscle tone in the thumb muscles. These are the stages that people begin to drop things for no apparent reason or wake up at night shaking the life back into their hands
“Nah, it’s not carpal tunnel syndrome, because my arm and shoulder hurt,” you say.
Perhaps, but there is an interesting twist to carpal tunnel syndrome; Many patients come into the office complaining of arm and even shoulder pain, only to learn that the carpal tunnel syndrome is causing this radiating pain. Boy, are they surprised!
So, how do you find out if that’s what you have?
There are several tests to diagnose carpal tunnel syndrome. They can be ordered through your family doctor, or more commonly, through a specialist that he/she would refer you to.
One of the most important diagnostic tools is the clinical examination, where the specialist can perform a variety of maneuvers and tests to gain more insight into the problem. Once the diagnosis has been made, you may be asked to have a diagnostic study performed called a nerve conduction study or electro-myogram (EMG), an electrical study that documents the pressure on the nerve as well as any alteration in its function by measuring nerve impulses from one point to another as they pass through “the tunnel.”
Once you have a definite diagnosis, and depending on the severity and duration of symptoms, treatment options can range from oral anti-inflammatory drugs, to “night splints” for the wrist(s), to cortisone injections. In the moderate-to-severe cases, surgical release of the pressure is almost always indicated.
Carpal tunnel release surgery is typically an out-patient procedure and can be done under a variety of anesthetics. It is very short, lasting less than 30 minutes. There will be stitches to eventually remove in the office, and you will have a bandage/dressing for protection. Your activities may be limited for several weeks.
If you feel you may be experiencing any of these symptoms, contact your doctor, or health care provider.
(Picture courtesy of Google Images, www.nlm.nih.gov)
Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. He holds multiple national certifications in these specialties. His goal is to empower people through education and information to become more engaged, proactive and responsible in their orthopedic health, and health care.