Carpal tunnel syndrome is a very common problem that we see in our orthopedic clinic. It’s compression or pressure on a nerve that passes through the wrist area on the palm side of the hand and causes numbness and tingling in the thumb, index, middle finger, and sometimes half of the ring finger.
Many times patients come in complaining of being unable to sleep at night. They wake up in the middle of the night with their fingers and their hand going numb, dropping things. Most of the time, it’s very debilitating because they can’t sleep. That’s the primary reason they come in.
Carpal tunnel is a small space that's in the center of the wrist. Carpal tunnel is the swelling of tendons in a very tight space. When the swelling gets to a certain point, the nerve gets compressed and squeezed, and all these symptoms occur.
So many things can cause that nerve to be compressed. Primarily it’s swelling in the tendons that go into the hand. Many different things can cause it, including pregnancy, overuse activities, excessive use of the hand, strenuous activities.
Some diseases can also cause or predispose you to swelling in the flexor tendons, including diabetes and thyroid issues. But it is primarily repetitive use and overuse of the wrists that causes swelling in those flexor tendons. That could be too much tennis, too much time on the computer, too much gardening, sometimes also too much cooking, cleaning around the house.
Many times patients are predisposed to swelling and then they do those activities and then it presents as excessive swelling in those flexors tendons.
Pregnant women, patients with some underlying diseases, such as diabetes and thyroid issues, are at the greatest risk. Then, there are patients that are active, that do day-to-day activities that cause their hands to swell.
Most of the patients that come to our office present with numbness and tingling in the thumb, index, and middle finger. Sometimes it’s pain. Sometimes it’s waking up at night with their hands numb and asleep. But day-to-day activities, such as driving a car, can cause numbness and tingling in those fingers with carpal tunnel syndrome.
When carpal tunnel syndrome gets worse, it has a tendency to cause you to get weak in your hands. When that happens, you drop things. You drop cups. You drop bigger objects that you’re trying to pick up. But the majority of the patients come in with numbness and tingling and night symptoms.
We always try to treat conservatively. We send patients to therapy. We have them take anti-inflammatories. They can use nights splints to sleep at night, and that can really help with the numbness and tingling symptoms at nighttime. Therapy can help to an extent. Sometimes we’ll even do a cortisone injection to reduce the swelling around those tendons and help to take the pressure off the nerve.
If all that fails and the symptoms progress, then there is carpal tunnel surgery, which we can do to fix it. It’s a very effective way of getting rid of carpal tunnel syndrome.
Surgery involves taking the pressure off the nerve or opening the space for the carpal tunnel. The carpal tunnel is the space underneath this big ligament. The surgery involves making a cut through this big thick ligament. Once you make that cut, the ligament is open and it takes the pressure off the nerve. It’s very effective.
Recovery from carpal tunnel surgery is anywhere from two to three weeks. You can get back to doing most activities. The hand stays a little weak for up to a month, but the symptoms go away within the first week of surgery most of the time.
Avoid repetitive activities, especially strenuous repetitive activities. We have patients that come in and have spent eight hours in the garden, cutting and shearing things. That’s really hard on your hands.
What helps is if you take frequent breaks and do some stretching exercises where you can stretch the fingers. This will help redistribute the swelling around the tendons to not focus on the carpal tunnel area. Do things in moderation and wear protective braces if you are susceptible to carpal tunnel syndrome. But the less you do repetitively for a prolonged period of time, the less likely you are to develop it.
There are some wrist exercises that the therapists find useful, and there are some that have been presented to be beneficial. Primarily the therapists will teach you how to do stretching exercises of the flexor tendons. So you try to stretch your fingers out straight, bend them down, wrist flexion, wrist extension. There’s also a stretching exercise with the rubber band that the therapists like to use, where you put a rubber band around the tip of the fingers and you kind of work at stretching them out and bending them down. This kind of takes a little bit of pressure off the nerve, and it helps to get the tendons to move a little easier in the carpal tunnel.
The stretching exercises can be helpful, even if you have pain, especially if you’re waking up at night. Some patients will run their hand under hot water and do those stretching exercises. The rubber band exercise is more of a preventative thing, but the finger stretching exercises can help, even if you wake up with symptoms in the middle of night.
As soon as it starts waking you up at night, really that is the primary reason to come in.
Carpal tunnel syndrome is a very common problem that we see in our hand clinic. It really comes down to being a problem with overuse of your hands on a day-to-day basis, doing too many things.
It’s important to understand that when you do develop symptoms — your fingers are going numb and tingly, waking you up at night and keeping you from doing things — it’s time to come in and get evaluated.
Lighly edited for clarity.
Watch the San Diego Health video with host Susan Taylor and Dr. Pacelli discussing the causes, symptoms and treatments for carpal tunnel syndrome.