Carpal tunnel syndrome is the most common “pinched nerve” condition that neurologists see. It is a form of compression neuropathy The typical patient comes in with complaints of hand or arm pain associated with one or more numb fingers. There is usually sparing of the little finger. This painful numbness will frequently wake affected patients from their sleep. They will complain of a swollen feeling in their hand (or both hands) associated with painful numbness affecting all but the little finger.
Carpal tunnel syndrome is caused by compression of the median nerve (the “carpal tunnel nerve”) as it pass under the carpal tunnel ligament. The carpal tunnel is located at the wrist. There is a small band of tissue across this to hold down the median nerve and vein. When the carpal tunnel becomes too narrowed, the median nerve becomes “pinched” and the vein is compressed. This combination of events results in the hand becoming numb and swollen. Carpal tunnel symptoms frequently occur only at night, during sleep. This is because we all have a tendency to sleep with our wrists slightly flexed. This position further narrows the carpal tunnel, causing symptoms. As the carpal tunnel narrows further, with time, patients will develop daytime hand numbness. Holding a newspaper, magazine or steering wheel can bring on symptoms. In more severe cases hand grip weakness can occur. Patients find that they have difficulty removing jar lids or may drop objects. Carpal tunnel syndrome occurs in both hand about 50% of the time.
CTS is diagnosed, most commonly by a neurologist, on the basis of the patient’s symptoms and detailed neurological exam. Electrical diagnostic testing, nerve conduction studies (NCV), are necessary to confirm carpal tunnel syndrome – particularly if surgery is being considered. Many patients can have carpal tunnel symptoms and have normal NCV studies. These patients are not candidates for surgery. The standard of care medical treatment for CTS is wearing a cock-up wrist brace. These braces prevent wrist flexion, thereby reducing the pressure on the median nerve. Frequently patients can “cure” their CTS with wearing a brace. For more severe symptoms with abnormal NCV studies, surgical decompression may be indicated. This is a procedure done under local anesthesia. A small incision is made at the wrist and the carpal ligament is cut. This relieves the pressure on the median nerve. Success rate for this surgery is approximately 90%.
If you feel that you have carpal tunnel syndrome, you should see a neurologist and have diagnostic studies performed. Most patients will do well with conservative, non-surgical treatment. For more detailed information click here.