Carpal Tunnel Symptoms

What Causes Carpal Tunnel Symptoms?

Carpal tunnel symptoms originate in the wrist. The wrist contains a narrow passage between the bones, muscles and transverse carpal ligament where nine flexor tendons, the median nerve and the smaller ulnar nerve pass through to the hand. The median nerve and the tendons provide function, feeling, and movement to the thumb, forefinger, middle finger and half of the ring finger. Carpal tunnel symptoms are caused when the median nerve, which runs through the passage in the wrist, is compressed causing symptoms of numbness, tingling, pain and loss of hand function. The dominant hand is usually the first affected with carpal tunnel symptoms.

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Carpal Tunnel Symptoms

The symptoms of carpal tunnel syndrome include:

1.    Numbness

One of the main carpal tunnel symptoms is the occurrence of numbness in the palm of the hand, the thumb, the index and middle fingers. The small finger is not usually affected at all.

2.    Tingling

Another of the common carpal tunnel symptoms is tingling or a “pins and needles” sensation in the hand, the thumb, the index and middle fingers. Again the small finger is not usually affected. In some patients the ring finger is also unaffected. This tingling sensation can be severely painful causing complete loss of use of the hand. The sensation feels like the blood supply to the hand has been restricted and then released.

 3.    Burning

Some patients experience a constant burning sensation in the palm of the hand. The burning sensation may present first then the numbness and tingling later.

 4.    Itchiness

Many patients complain of their hands becoming itchy although this is not the most common of carpal tunnel symptoms.

 5.    Aching Hands

Some patients may experience aching in the palm of their hands. Sometimes the aching extents back up the arm towards the elbow.

6.    Stiffness in the hands and wrists

Some patients may experience stiffness and difficulty moving their hands and wrists. This is more apparent in the morning when the patient wakes or when they begin working.

 7.    Shooting pains from the wrist

Some patients may experience darting or shooting pains back up their lower arm towards their elbow. Occasionally the shooting pains can extend into the palm of their hand.

8.    Hands feel sweaty or cold

Another of the common carpal tunnel symptoms is when some patients may experience sensations of coldness or hot and sweatiness in their hands. Other patients complain about losing the ability to differentiate hot from cold sensations.

9.    Weakness of the hand

Many sufferers report significant loss of grip strength in their hands although this is more difficult to measure and classify. These carpal tunnel symptoms are also associated with arthritis which commonly occurs in older carpal tunnel sufferers. If the condition is not treated weakness and atrophy of the hand and wrist muscles may become worse.

Many patients experience their hands easily becoming tired, loss of dexterity, decreased grip strength and the hands generally becoming weaker than normal.

10.  Loss of hand function

Patients with advanced carpal tunnel symptoms will lose some degree of function with their hands. As the “thenar” muscles of the thumb are controlled by the median nerve, patients with advanced carpal tunnel symptoms may lose function of the thumb and experience difficulty holding objects.

Common examples include difficulty playing a musical instrument, difficulty tying a shoelace, hand writing is difficult and messy, typing on a keyboard has become difficult, being clumsy with their hands, dropping objects and fumbling when holding objects.

 11.  Associated pain in the arm, elbow and shoulder

Some patients complain of pain up to their elbow when using their affected hands. Other patients can even develop associated pain in their shoulder region from this condition.

 12.  Pain at night

It is common for sufferers to wake up in the middle of the night with their hand and wrist aching and tingling. These carpal tunnel symptoms are often caused by sleeping with the hand in a flexed position and/or having a build-up of fluid around the wrist causing the carpal canal to be restricted and placing pressure on the nerve.

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Median Nerve Causes Carpal Tunnel Symptoms
 

False Carpal Tunnel Symptoms

A common problem with carpal tunnel symptoms is misdiagnosis. There are many other conditions that have similar symptoms to carpal tunnel symptoms but are not caused by the compression of the median nerve.  However, these false symptoms need to be followed up by a visit to your medical practitioner.

The following problems cause temporary or permanent false carpal tunnel symptoms.

Before the median nerve passes through the carpal passage it passes through the thoracic outlet and the two heads of the pronator teres muscle within the forearm. Any compression, inflammation or hypertrophy of these structures may irritate the median nerve producing a very similar set of symptoms to carpal tunnel syndrome. There may also be pain in the arm and elbow.

Sometimes people wake up in the middle of the night with a “pins and needles” sensation in their hand(s) and sometimes the sensation can affect the whole lower arm. The lower arm and hand may be completely paralyzed, without function and quite painful. This condition is most often caused by the individual laying on the arm or hand causing restricted blood flow to the affected limb. After moving the position of the arm normal blood flow will recommence and the arm and hand will return to normal function within a short period of time.

Tingling sensations in the hand, wrist and lower arm can be caused by many other conditions such as inadvertently knocking the elbow’s “funny bone” causing temporary irritation and compression to the nerve in the elbow. A fall or sudden pressure to the arm or hand can cause blood vessel or nerve compression resulting in symptoms similar to carpal tunnel. Golfer’s elbow and tennis elbow can cause numbness, tingling, pain and stiffness that may affect the lower arm, wrist and hand. These are not carpal tunnel symptoms.

Injury to the lower arm or hand, such as muscle strains, tendonitis or bone fractures can also cause symptoms similar to carpal tunnel symptoms.

Carpal Tunnel Causes

The cause of each case of carpal tunnel syndrome is often not able to be isolated but tends to be caused by a combination of contributing factors.

 1.    Overuse Injury

One of the most common causes of carpal tunnel symptoms is thought to be overuse of the hands in a repetitive, forceful motion or a specific wrist posture that places undue strain on the wrist. This strain leads to inflammation of the tendons causing the carpal passage to become restricted or squeezed. While a link to occupational activities has not been proven there has been a rise in work-related claims.

Examples of overuse causing carpal tunnel symptoms include:

• Typing
• Playing a musical instrument eg. piano.
• Assembly line work that is highly repetitive.
• Use of power tools causing excessive vibration.
• Twisting motions eg. using a screwdriver.
• Sports such as golf or racquet sports.
• Carpentry, painting, chopping wood, bricklaying.
• Sewing, knitting.

 2.    Pregnancy

Pregnancy can cause temporary carpal tunnel symptoms that usually resolve quickly after childbirth. When a woman becomes pregnant the changes in hormone production (eg. high progesterone production) cause a higher than normal level of fluid retention within the body. This extra fluid can result in swelling of the wrists and hands exerting extra pressure on the carpal ligament and median nerve. After childbirth the body rapidly returns to a normal fluid retention level and the swelling resolves by itself reducing or eliminating the carpal tunnel symptoms.

3.    Hypothyroidism

Similar to pregnancy, hypothyroidism can cause an increase in fluid retained in the tissues causing swelling that leads to the carpal tunnel symptoms of wrist and hand pain. Excessive production of growth hormones can cause the soft tissue and bones in the wrist to enlarge thus reducing the space in the carpal canal places pressure on the median nerve.

 4.    Diabetes

Similar to pregnancy, diabetes can lead to fluid retention or inflammation of the carpal canal causing carpal tunnel symptoms.

5.    Arthritis

It is well-known that rheumatoid arthritis causes inflammation and swelling of the flexor tendons which can lead to carpal tunnel symptoms that can be quite painful.

6.    Genetics

Some individuals may inherit a narrow carpal canal, small wrist, vascular malformation, enlarged wrist bones or some other congenial factor that makes them more prone to developing carpal tunnel symptoms.

 7.    Trauma

A wrist injury or fracture can reduce the volume of space in the carpal canal leading to irritation of the median nerve. Damage to the flexor tendons within the wrist may cause swelling and inflammation of the tendons engulfing the carpal canal and compressing the median nerve. X-rays of the wrist may help to identify any wrist injury or narrowing of the canal causing carpal tunnel symptoms.

8.    Obesity

Individuals who are classified as obese have recorded carpal tunnel symptoms two and a half times more than individuals of normal body mass index and weight.

 9.    Oral contraceptives

There is some evidence from empirical medical studies that women taking the oral contraceptive are at a higher risk of developing carpal tunnel symptoms.

10.  Tumors & Diseases

Benign tumors (such as Ganglion, lipoma) can cause pressure to be exerted on the carpal tunnel and median nerve. However this is in very rare cases. Certain rare diseases such as leukemia, amyloidosis or sarcoidosis can cause abnormal changes in and around the carpal passage causing nerve irritation.

People at Risk of Carpal Tunnel Symptoms

People who are at higher risk of developing carpal tunnel symptoms.

• Older people are affected much more than younger people.
• 90% of cases occur in people older than 30 years.
• Women between the ages of 45 and 65 years.
• Women are 3 times more susceptible than men.
• Women during pregnancy due to swelling of the wrists.
• Caucasians have the highest risk compared to other races.
• People who are overweight are more susceptible to developing carpal tunnel symptoms due to increased tissue pressure in their wrists
• People with various types of arthritis commonly develop carpal tunnel symptoms.
• Individuals who use their hands in repetitive movements (eg. typing, playing piano) are more susceptible to developing carpal tunnel symptoms.

Prevention of Carpal Tunnel Symptoms

Many medical experts presume that carpal tunnel symptoms are not preventable especially when caused by genetic and structural abnormalities.

However, other medically trained individuals believe that carpal tunnel symptoms is primarily caused by forced activity and can be prevented by adopting healthy practices in the workplace such as avoiding stressful, repetitive tasks that twist and strain the wrist. People in high risk groups can change to a healthier diet, increase exercise and use ergonomic equipment.

What is Tarsal Tunnel Syndrome?

Tarsal tunnel has the same symptoms as carpal tunnel symptoms but in the foot. The anatomy of the ankle and foot is similar to the wrist and hand. There is a sensory nerve that travels through a canal in the ankle to the foot. This canal is called the tarsal tunnel – the name is derived from the Latin word for ankle. When the tarsal tunnel is compressed the nerve is affected causing numbness, tingling and pain in the foot and toes. This condition is far less common than carpal tunnel syndrome. The treatment for the condition is very similar to the treatment for carpal tunnel symptoms.

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Carpal Tunnel Symptoms Diagnosis

A doctor will make a clinical examination of the patient to diagnose carpal tunnel symptoms.

Phalen’s test is performed by fully flexing the wrists to their maximum position and holding for a short period of time (typically one minute) until symptoms present. Flexing the wrists to 90 degrees will reduce the size of the carpal canal causing compression of the nerve in patients with carpal tunnel symptoms. The patient may be diagnosed with carpal tunnel symptoms if numbness or tingling results. The quicker the symptoms present, the more advanced the carpal tunnel symptoms.

Tinel’s test is to detect nerve irritation by tapping over the wrist and palm to cause tingling or “pins and needles” sensation in the hand and fingers.

Durkan’s test is to apply firm pressure to the base of the palm over the median nerve and carpal tunnel for up to 30 seconds until symptoms present.

Electrophysiological testing determines carpal tunnel symptoms

Electrophysiological testing can determine the degree of carpal tunnel symptoms.

When the median nerve is compressed it will conduct more slowly or poorly compared to other nerves.

Electro-diagnostic testing measures the speed of conduction to determine whether the nerve is under stress or not.

A patient with true carpal tunnel symptoms will never suffer any sensory loss, numbness or tingling in the base of the palm and at the base of the thumb because the branch of the median nerve that innervates those areas of the palm branches off the median nerve before the carpal tunnel passing around the carpal canal not through it.

Patients whose only symptom is pain are unlikely to have carpal tunnel symptoms. Patients with intermittent numbness and tingling often are only mild cases of carpal tunnel symptoms and not serious enough to be considered candidates for surgery.

Misdiagnosis of carpal tunnel symptoms

Misdiagnosis is common with carpal tunnel as there are many other conditions that have similar symptoms. Before the median nerve passes through the carpal canal it passes through the thoracic outlet and the two heads of the pronator teres muscle within the forearm. Any inflammation, compression or hypertrophy of these structures may irritate the median nerve producing a very similar set of symptoms to carpal tunnel syndrome. There may also be pain in the arm and elbow.

Carpal Tunnel Symptoms Treatment

The patient with carpal tunnel symptoms has a number of treatment options available.

 1.    Immobilization

The first and most simplistic treatment is to immobilize the hand and wrist by wearing a wrist brace or splint. This keeps the wrist straight, preventing movement and helps to rest the wrist. A brace or splint is particularly useful at night to prevent undue wrist movement while sleeping.

If there is heat in the wrist area the application of an icepack may be of benefit.

 2.    Physiotherapy & Massage

There is much evidence to show that when carpal tunnel symptoms first present and in milder cases of carpal tunnel symptoms physiotherapy and wrist exercises can be effective to control and relieve the carpal tunnel symptoms.

When a pregnant woman has developed carpal tunnel symptoms, the only safe carpal tunnel treatment option is to use natural methods until after the baby is delivered.

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 3.    Chiropractic

Some patients have claimed that chiropractic manipulation of the wrist and hand has helped relieve carpal tunnel symptoms. Patients who work with computer keyboards may gain some benefit from adjusting their chair height to maintain straight wrists and a more comfortable position.

Introducing some wrist stretching exercises and more rest breaks into their daily routine may dramatically reduce the carpal tunnel symptoms that are apparently caused by repetitive overuse of the hands.

4.    Drug Therapy

Non-steroid anti-inflammatory drugs are often prescribed to reduce the inflammation and swelling in the wrists. These drugs may have unwanted side-effects including gastro-intestinal upset and abdominal pain.

5.    Cortisone Steroid Injections

Some doctors will recommend an injection of local anesthetic and a corticosteroid into the wrist to reduce the carpal tunnel symptoms of pain and swelling. The injection can be very effective to eliminate the pain. However, this is a short-term solution only. Usually the doctor will only ever give one injection as the treatment is quite aggressive and not recommended for an extended period of time. Corticosteroids should never be given to patients with diabetes.

 6.    Surgery

If all of the above treatment options yield no result then the final option is an operation to relief the pressure on the median nerve.

Surgery is only recommended when there is advanced carpal tunnel symptoms of constant numbness, tingling, muscle weakness and pain that cannot be relieved by other treatment options.

Untreated Carpal Tunnel Symptoms

There are cases of carpal tunnel symptoms resolving themselves over time without treatment. However, this tends to be the exception to the rule. Normally if carpal tunnel symptoms are left untreated they may progress into more severe symptoms.

As with all medical problems, it is strongly recommended to take action as soon as you become aware of the condition. If a medical condition is not properly diagnosed and treated as soon as possible the condition may develop into a more severe case and be much more difficult to effectively treat. If left untreated carpal tunnel symptoms can result in permanent muscle and nerve damage and loss of function to your hands.

Operation for Carpal Tunnel Symptoms

People who have developed advanced carpal tunnel symptoms including severe or constant pain, tingling or numbness and have lost (or partially lost) the usefulness of their hands may opt for an operation to relieve their carpal tunnel symptoms.

The carpal tunnel operation may be performed on one or both hands together. Depending on the case, the surgery can be performed under local or general anesthetic.

If performed under general anesthetic, the patient may be required to arrive at the hospital the night before if the procedure is carried out early in the morning. The patient may be required to fast (not eat) for a period of time before surgery. Less severe cases may be treated under local anesthetic as a day procedure and the patient can usually go home several hours later.

Surgical Techniques to Relieve Carpal Tunnel Symptoms

There are several different surgical techniques employed to relieve the pressure on the median nerve. The most common procedure to relieve carpal tunnel symptoms is to cut the transverse carpal ligament, which is the structure causing the compression of the carpal tunnel and resulting pressure on the nerve. During the operation the surgeon makes a small incision (usually between two and five centimeters long) into the palm and wrist of the affected hand.

The endoscopic surgery technique involves making one or two small incisions (usually only one centimeter) to enable endoscopic instruments to be introduced into the underside of the transverse carpal ligament. This surgical method is less damaging to the surrounding tissues, leaves less scaring and results in a faster recovery time from carpal tunnel symptoms. However, there is a slight increased risk of damage to the median nerve.

Balloon carpal tunnel plasty is another technique to eliminate carpal tunnel symptoms which involves inserting a balloon catheter through a very small incision into the carpal canal. The balloon is gently elevated to increase the cavity space in the tunnel. This technique avoids cutting the carpal ligament and surrounding tissues. There is only a small incision and fast recover time.

During the healing process, which may take several weeks, the severed carpal ligament will grow back together resulting in less tension on the carpal nerve.

After Surgery

After the operation the patient may be required to stay overnight in the hospital for observation. Generally, the patient should not be allowed to consume food or fluids for at least four hours. The patient’s wrist(s) is placed in a wrist constraint and sling to prevent movement, reduce swelling and reduce carpal tunnel symptoms.

The carpal tunnel procedure can be painful and uncomfortable for several days after the operation requiring the patient to take prescription pain-killers. The patient may need to apply a cold pack to the wrist to control swelling and pain.

A few days after the operation, the patient will be given instructions to perform some basic hand and wrist exercises to regain function and movement.

About two weeks after surgery, the doctor will remove your sutures and examine your hand.

Patients are advised to immobilize and rest their hand(s) during the first four weeks post-operative, otherwise carpal tunnel symptoms may return. They will not be able to return to work or perform any manual activities around the home until the hand has healed.

Usually relief from the pain and other carpal tunnel symptoms is realized immediately after surgery. However, in some patients the relief can be more gradual over the next few weeks. Tenderness around the incision may last for several months.

Carpal Tunnel Surgery Complications

As with all surgery there may be risks such as:

• Abnormal swelling in the wrist.
• Redness or heat in the wound.
• Infection of the wound requiring antibiotic treatment.
• Damage to the median nerve causing continuing symptoms.
• Damage to surrounding tissue or blood vessels.
• The transverse carpal ligament may develop excess scar tissue causing some pressure on the nerve.
• The ligament may not have been completely cut resulting in continuing pressure on the median nerve and continuing carpal tunnel symptoms

Here is a video of surgery to relieve the pain from carpal tunnel symptoms.

Carpal Tunnel Symptoms Surgery Video

If you are experiencing carpal tunnel symptoms try this simple exercise regime. This will compress and open the carpal canal while strengthening your wrist muscles. Naturally, if you carpal tunnel symptoms become worse stop immediately and see your doctor.

Exercise for Carpal Tunnel Symptoms

1. Hold your arms out straight in front of your chest, at ninety degrees angle to your body.
2. Lift your fingers and palms straight up, so that your wrist is bent at 90 degrees. Hold the position for 5 seconds.
3. Relax your hands and wrists while holding your arms out straight in front of your chest. Hold the position for 5 seconds.
4. Now make tight fists with both hands and gradually bend your wrists downward, so that your knuckles are pointing to the floor. Hold the position for 5 seconds.
5. Relax your hands and wrists while holding your arms out straight in front of your chest. Hold the position for 5 seconds.
6. Repeat all the steps again ten times.

When finished, relax your arms and shake them out at your sides.

You may want to complete this exercise regime once daily for the first week and then increase to twice daily thereafter. You should feel relief from your carpal tunnel symptoms within a few days.