Carpal Tunnel Syndrome: Causes, Symptoms, Diagnosis and Effective Treatments

If you’ve developed pain, burning, or tingling sensations in your hand, you might be experiencing carpal tunnel syndrome. It’s something you shouldn’t ignore.

Affecting anywhere from 1% to 5% of the general population, carpal tunnel syndrome is a problem with the nerve that runs from the shoulder to the hand.

“Carpal tunnel syndrome is compression of the median nerve as it crosses from the wrist into the hand,” says Steven Maschke, MD, a Cleveland Clinic orthopaedic surgeon.

Left untreated, the disorder can lead to permanent damage and potentially debilitating complications.

What Is Carpal Tunnel Syndrome?

Several bones and ligaments (including the transverse carpal ligament) form the narrow carpal tunnel in your wrist and hand. Through that space pass the median nerve and nine tendons that bend your fingers.

The carpal tunnel can become inflamed and swollen and press on the median nerve, causing the hallmark carpal tunnel symptoms. Symptoms usually start slowly and build over time—months, years or even decades.

Causes and Risk Factors

In the past, carpal tunnel syndrome was often blamed on heavy computer/keyboard use, but guidelines from the American Academy of Orthopaedic Surgeons point out that no high-quality evidence supports this association.

However, many conditions that cause swelling in the wrist can cause carpal tunnel syndrome. Repetitive motion can exacerbate carpal tunnel symptoms, and people who use vibrating power tools are at increased risk. Other higher-risk groups include people over 40, women, those who are pregnant, and individuals with biological relatives with carpal tunnel syndrome. Other risk factors for carpal tunnel syndrome include health conditions such as arthritis, gout, hypothyroidism (underactive thyroid), diabetes, and obesity.

Signs and Symptoms

Early carpal tunnel symptoms may be subtle and occur only during certain activities.

“When you have compression of that nerve, one of the hallmark symptoms is people waking up at night with a burning, tingling sensation, usually in the thumb, index finger, and part of the ring finger,” Dr. Maschke says. Symptoms are often worse with activities like driving a car or using a weed trimmer or lawn mower.

“As things progress, carpal tunnel can get a little more sinister where you may have a more significant numbness affecting fine motor skills. Buttoning your shirt or picking up a screw or a pill can become challenging,” Dr. Maschke says. “The median nerve also supplies motor function to the fleshy muscles at the base of your thumb, called the thenar muscles. You may notice a flattening out of those muscles. You may have trouble bringing your thumb out of the plane of the palm to pinch and grip with your fingers. That can become permanent. When some people say, ‘I had carpal tunnel surgery and it didn’t help,’ those are most often people that waited so long for treatment they had nerve damage which couldn’t be reversed with surgery.”

How Is Carpal Tunnel Syndrome Diagnosed?

For most people, a careful medical history review and physical exam are the keys to diagnosing carpal tunnel syndrome.

Additionally, your provider might order an x-ray or other imaging. Sometimes, it is important to rule out nerve compression at the neck with x-rays or other imaging. An electromyography (EMG) test might clarify the diagnosis by measuring the response of muscles to electrical stimulation. A nerve conduction study can measure the flow of electrical current through a nerve.

Treatment Options

Carpal tunnel treatment will vary based on your symptoms. Exercises called nerve glides can be helpful in the early phases of the condition.

Nonsurgical treatment options include wearing wrist splints when sleeping or performing activities that cause symptoms, such as driving. Anti-inflammatory medications, like ibuprofen, can also help. A cortisone shot in the wrist may relieve symptoms temporarily and can sometimes be used to confirm the diagnosis.

“If you’re getting to the point where the EMG test results are severe or the symptoms are becoming very persistent, or if you notice any kind of thumb weakness, that’s when most people consider carpal tunnel surgery,” says Dr. Maschke, who regularly performs this operation.

During surgery, which is generally an outpatient procedure, the surgeon will release the transverse carpal ligament to create more space for the nerve, ease pressure on it, and relieve symptoms. The procedure is done through a small incision in the wrist or palm, and recovery takes a few weeks.

Risks of surgery include infection and anesthesia, as well as a more unusual complication called pillar pain, which is caused by scar tissue at the base of the wrist after surgery. The pillar pain usually goes away over time.

If the nerve damage is severe, surgery might not provide relief from symptoms. So, it’s important to consider treatment sooner rather than waiting until carpal tunnel syndrome leads to permanent nerve damage.

Prevention and Self-Care Tips

Paying attention to your wrist posture can help reduce the risk of carpal tunnel syndrome and relieve symptoms. Adjust your activities so your wrists can remain in a neutral position most of the time. Wearing a wrist splint can help remind you to maintain a neutral position.

It’s not possible for everyone to avoid carpal tunnel symptoms if they can’t avoid the activities that cause them. Importantly, don’t ignore the numbness and tingling.

Living with Carpal Tunnel Syndrome

The nonsurgical treatments like splinting, anti-inflammatories, and nerve glide exercises can help relieve symptoms day to day. If the symptoms are waking you up at night, hanging your arm over the edge of the bed can sometimes release the pressure on the nerve temporarily.

Dr. Maschke recommends seeking help if symptoms are persistent or you are having trouble with fine motor activities, and also getting prompt treatment to prevent permanent damage to your median nerve.