Question:

What is carpal tunnel syndrome, and can it be prevented?

Answer from Joseph Morgan, MD, orthopaedic surgeon and hand specialist:

Carpal tunnel syndrome is one of the most common conditions I treat as a hand surgeon, both surgically and nonsurgically.

There are a lot of misconceptions about carpal tunnel syndrome. I often hear from patients that they’re nervous about getting it checked out because they will have to have surgery. That’s not true. In fact, surgery is almost always a last resort. We usually recommend nonsurgical management first, and surgery is reserved for patients with persistent symptoms.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a compressive neuropathy or a pinched nerve in the wrist. The transverse carpal ligament crosses over the palm side of the wrist and creates a kind of belt to hold down the finger flexors and median nerve.

The median nerve can become compressed for a variety of reasons. Anything that causes the hand to swell can cause carpal tunnel syndrome. Some of the most common reasons include:

• Injuries that cause swelling, such as a broken wrist.
• Overuse from performing certain activities.
• Frequent occupational exposures to vibrational tools or repetitive gripping and grasping.
• Certain systemic illnesses and health conditions, such as diabetes and hypothyroidism.
• Pregnancy.

Carpal tunnel syndrome often manifests with numbness and tingling in the three and a half fingers on the thumb side of the hand. It’s typically bothersome at night and may cause you to lose sleep. You may also develop weakness in your hand that makes it harder to grip small objects, such as coins or buttons, and can cause you to drop things frequently.

How is carpal tunnel diagnosed and treated?

Often, we diagnose patients just by talking to them and examining their hands. There are tests that can help us determine whether you have it, like ultrasound or nerve tests, but they are not always necessary.

Treatment for carpal tunnel syndrome includes the following:

1. Wearing a splint. Treatment often begins by wearing a splint at night for around six weeks. For many patients, this resolves their issues.
2. Steroid injections. I don’t generally recommend injections as a standard treatment, but there are certain patients for whom it’s a great option.
3. Surgery. For patients with symptoms that don’t improve with nonoperative treatment, we offer carpal tunnel release surgery in the clinic under local anesthesia. It takes about five minutes and is done through a small incision that usually requires only two stitches. There is typically no downtime after the procedure and most patients find it extremely easy, leading to pronounced relief of their symptoms.

Can carpal tunnel syndrome be prevented?

Carpal tunnel syndrome can happen for several reasons, and it is hard to predict who might get it. However, a few preventive measures may reduce your risk. These include:

• Avoiding repetitive gripping and grasping.
• Avoiding the use of vibrational tools for long periods.
• Maintaining good health habits and doing your best to avoid health problems like diabetes, if possible.

Around 28% of pregnant women without prior symptoms will develop some degree of carpal tunnel syndrome by the third trimester due to swelling in their hands. Their symptoms almost always resolve within six weeks of giving birth. However, this is one group of people for whom steroid shots can be extremely effective if symptoms become too uncomfortable during pregnancy. If someone still has symptoms at three months postpartum, they should be evaluated toward further treatment.

If you are experiencing numbness, tingling, pain or weakness in your hands, know that these symptoms are abnormal and should always be checked out by a health care provider. Nonsurgical treatment may be effective in resolving your symptoms. If surgery becomes necessary, we offer a minimally invasive, in-clinic procedure. However, if carpal tunnel syndrome goes untreated for too long, it can become permanent in certain cases.