Carpal tunnel syndrome is one of the most common nerve disorders, yet it remains surrounded by many myths and misconceptions. Is carpal tunnel caused by too much typing or computer work? Are wrist braces helpful or will they weaken your wrists? Does surgery cure carpal tunnel for good?
Let’s explore some common carpal tunnel myths and separate fact from fiction. With accurate information, you can make informed decisions about preventing and managing this condition. We’ll debunk carpal tunnel misconceptions using the latest medical evidence and help you understand the realities of living with this common nerve compression disorder.
Here’s everything that you need to know about this all-too-familiar cause of wrist pain.
What Is Carpal Tunnel Syndrome?
It is a widely reported condition caused by compression of the median nerve as it travels through the wrist at the carpal tunnel. The main symptoms are pain, numbness, and tingling in the hand and fingers. It is the most common nerve compression disorder that affects hands and arms. It can occur in one or both hands and is more common in women than men.
The pain associated with carpal tunnel syndrome may radiate up the arm. Weak grip strength is a typical symptom and you might have difficulty performing fine motor tasks such as writing or buttoning your shirt. In more severe cases, the muscles at the base of your thumb may visibly waste away.
What Is the Carpal Tunnel?
While we rarely talk about this body part outside of conversations about wrist pain, a carpal tunnel is indeed a part of your body. The carpal tunnel is an anatomical compartment in your wrist that houses your nine flexor tendons and median nerve. These nerves and tendons travel from your forearm into your hand.
Your carpal tunnel consists of the carpal bones on the sides and the transverse carpal ligament on the top. This structure creates a narrow passageway for the median nerve, which lies just under your transverse carpal ligament. Any condition that decreases the total area of the carpal tunnel or increases the volume of structures inside of it can put pressure on your median nerve.
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome has a number of possible causes. Most cases are idiopathic, meaning the exact cause is unknown. While doctors aren’t able to pinpoint the specific cause in each case, we do know a range of things that make it more likely.
Carpal tunnel syndrome risk factors include repetitive hand use, obesity, hypothyroidism, arthritis, diabetes, and trauma or injury to the wrist. Pregnancy can increase fluid retention and swelling, compressing the median nerve and boosting your risk.
There are a number of factors that can increase the risk of developing carpal tunnel syndrome:
- Repetitive motions: Repeated manual work that involves prolonged wrist flexion or extension can irritate the median nerve. Forceful gripping also increases risk. Examples are typing, knitting, playing an instrument, carpentry, cleaning, cooking, manufacturing or packaging work.
- Hand trauma: Previous injuries including bone fractures or dislocations can alter carpal tunnel anatomy. Ligament damage allows contents to bulge and put pressure on the nerve.
- Obesity: Excess body fat increases risk, possibly from fluid accumulation around tendons. Weight gain during adulthood is linked to higher risk.
- Fluid retention: Edema compresses the median nerve. Causes include pregnancy, menopause, thyroid disease, congestive heart failure, or certain medications.
- Inflammatory arthritis: Rheumatoid arthritis causes thickening of flexor tendons. Tenosynovitis inflames the tendon sheaths.
- Diabetes mellitus: High blood glucose levels affect peripheral nerves and make them more susceptible to compression. Poor glucose control increases risk.
- Hypothyroidism: Carpal tunnel is more common in people with an underactive thyroid gland. The mechanism is unclear but may involve fluid accumulation.
- Genetics: This can predispose someone to developing carpal tunnel syndrome. It tends to cluster in families.
- Female sex: Twice as common in women than men, linked to smaller carpal tunnel size. Worsens after menopause.
- Age: Risk increases over age 40 but can occur at any age. The median nerve becomes less tolerant of compression.
- Anatomic factors: Smaller carpal tunnel, square-shaped wrist, or certain bone alignments may increase risk.
- Stress: Chronic stress may contribute to increasing inflammation and swelling.
- Workplace factors: Force, vibration, and cold temperatures can also play a role. Poor ergonomics stresses the wrist.
This painful condition is linked to occupations and hobbies that involve repetitive and forceful use of the hands and wrists. This includes things like typing on a keyboard whether you’re working from home or in the office, working on an assembly line, playing musical instruments, or knitting. It is important to note, however, that carpal tunnel syndrome is unlikely to develop solely from repetitive computer use in the absence of other risk factors.
Regardless of the cause and each person’s specific risk fact, the dominant hand is affected first in almost all cases.
How Carpal Tunnel Syndrome Works
When we talk about carpal tunnel syndrome, we are talking about the compression of the median nerve inside the carpal tunnel of your wrist. Chronic increased pressure on the nerve may result in demyelination (damage to protective nerve fibre coating) and fibrosis (excessive formation of fibrous tissue). This pressure causes a disruption of your nerve‘s blood supply, which can lead to ischemia (restricted blood flow to tissue).
Studies have shown evidence of inflammation of the tenosynovium (synovial sheath surrounding the tendons) in the carpal tunnel. The flexor tendons swell and put more pressure on the median nerve. Scar tissue formation over time also gradually and increasingly affects the diameter of the tunnel.
Carpal Tunnel Syndrome Symptoms
Symptoms of carpal tunnel syndrome begin gradually and progress over weeks to months. Carpal tunnel syndrome causes a wide range of symptoms in the hand including:
- Numbness or tingling in your thumb, index finger, middle finger, and half of the ring finger. Pain typically begins in the thumb and first two fingers.
- Night pain or throbbing that may wake you up.
- Wrist pain that may radiate up the arm.
- Difficulty with fine motor tasks requiring dexterity.
- Burning, aching or shooting pain in the affected fingers or hand.
- A feeling of swelling in the fingers or hand.
- Signs of inflammation like redness or warmth.
- Dry skin, peeling or cracking on the fingertips.
- Hand cramps.
- Weakness with gripping, grasping or pinching motions; e.g. difficulty opening jars.
- Numbness or tingling that worsens with sustained hand or wrist flexion. Shaking hands brings relief.
- Difficulty distinguishing hot/cold and sharp/dull sensations in the fingers.
- Muscle atrophy at the base of your thumb leads to a deep hollow.
- Weak thumb pinch.
- Clumsiness handling small objects like buttons or coins. Trouble manipulating keys.
- Decreased grip strength when shaking hands or picking up items. Tendency to drop things.
- Impaired dexterity with activities like writing, sewing or assembling items.
Mild or Moderate Carpal Tunnel Syndrome
There are different stages of carpal tunnel syndrome and it is important to be able to distinguish between them. To help you assess how severe your case may be, let’s take a look at specific symptoms you will experience in the early stages of carpal tunnel syndrome.
- Tingling, numbness, or buzzing sensations in your thumb, index and middle fingers. The pain may come and go but is probably more noticeable at night.
- Mild hand or wrist discomfort that is worse with certain motions like prolonged gripping. Pain may radiate up the arm.
- Clumsiness handling small objects or trouble manipulating buttons and zips. Occasional dropping of items.
- Temporary finger numbness or tingling with forceful pinching or gripping. Quick hand shaking will usually bring relief.
- Stiffness, tightness or aching in the fingers or hand, especially in the morning after you wake up.
- Occasional difficulty discerning hot/cold and sharp/dull sensations in your fingertips.
- Mildly weakened grip or difficulty opening tight jars.
- Fatigue with sustained fine motor tasks.
- Nighttime pain that wakes you up and makes it hard to get back to sleep.
- Symptoms are aggravated by activities like typing, knitting, cycling or playing an instrument.
- Symptoms are relieved by rest and limiting repetitive or forceful hand motions.
Severe Carpal Tunnel Syndrome
In longstanding carpal tunnel syndrome, compression of your median nerve leads to worsening symptoms such as the following:
- Constant tingling, numbness, and pain extending from your wrist up into your arm and shoulder.
- Dramatic loss of hand strength and dexterity. Severely weakened pinch and grip. Difficulty holding onto items.
- “Pins and needles” sensations, burning or electric shock-like pain in the affected fingers and hand.
- Muscle wasting in the thenar eminence at the base of the thumb (creating an altered hand contour).
- Loss of fine motor control. Trouble grasping small objects like coins, closing buttons and zippers or holding a pen.
- Sensory changes like hypersensitivity to touch or lack of fingertip sensations.
- Lack of sensation to hot/cold temperatures.
- Difficulty with tasks requiring finger dexterity.
- Constant numbness.
- Severe tingling and pain at night that regularly wakes you up.
- Loss of coordination. Frequent dropping of held objects and general clumsiness.
- Inability to oppose the thumb.
Check out our article to find out when minor injuries are more serious than you might think here.
How Doctors Test for Carpal Tunnel Syndrome
If you are dealing with wrist pain and discomfort, it is essential to see a healthcare professional. To help determine if you have this debilitating condition, your doctor may do some of the following checks:
- Physical exam: Looking for signs of weakness or atrophy of the thumb muscles, and decreased sensation in the median nerve distribution
- Medical history: Asking about symptom location, onset, aggravating factors, occupational hazards, and any hobbies requiring repetitive motions
- Nerve conduction studies: Measuring how fast electrical impulses travel through the median nerve compared to other nerves
- Electromyography: Checking for denervation changes in the thenar muscles supplied by the median nerve
- Ultrasound: Imaging the median nerve to look for swelling or flattening against the transverse carpal ligament
- MRI: Using magnetic resonance imaging to show compression of the median nerve and expanded carpal tunnel. This is not to be confused with X-rays or CTs. Check out this article to learn about the difference between MRIs, X-rays and CTs.
- Two-point discrimination test: Checking sensory discrimination in the median nerve fingers
- Phalen’s manoeuvre: Seeing if wrist flexion for 60 seconds brings on symptoms
- Tinel’s sign: Tapping on the median nerve to elicit tingling or shock sensations
- Durkan compression test: Applying pressure to carpal tunnel reproduces symptoms
- Blood tests: Checking for medical conditions associated with carpal tunnel like diabetes
Carpal Tunnel Syndrome Treatment Options
The best treatment for you will depend on your specific stage of carpal tunnel syndrome. After examining your wrist, your healthcare professional will determine your needs and create a customised wrist injury treatment plan.
Here are the main treatment options for carpal tunnel syndrome that your doctor may recommend to help you get rid of wrist pain:
- Wrist splinting: Wearing a rigid brace, especially at night, will help to keep your wrist in a neutral position and prevent pain and inflation.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Oral medications like ibuprofen are effective in reducing inflammation and eliminating pain.
- Corticosteroid injections: Injecting steroids into the carpal tunnel will relieve swelling and pressure on the median nerve and help to reduce your symptoms.
- Activity changes: Avoiding repetitive wrist motions and being conscious of how you are using your wrists can prevent flare-ups.
- Ergonomic changes: Improving your workplace setup and hand positioning during the day can reduce or sometimes even eliminate pain.
- Tendon gliding exercises: Targeted stretches to maintain your carpal tunnel space and allow your tendons to slide. Carefully following instructions from your physical therapist is key to successful recovery.
- Vitamin B6 supplements: Taking a daily B6 vitamin has been shown to help reduce inflammation.
- Yoga or pilates: Learning beneficial poses and stretches can reduce carpal tunnel compression.
- Massage: By releasing muscle tightness, you can reduce compression of your median nerve.
- Acupuncture: Fine needles can stimulate your healing responses and reduce swelling.
- Open carpal tunnel release surgery: In more severe cases, surgery to have your transverse carpal ligament cut will relieve pressure.
- Endoscopic surgery: Making small incisions to cut the ligament under camera guidance is a good option for many people.
- Post-surgical hand therapy: Stretches and strengthening exercises after surgery will aid your recovery.
In certain cases, platelet rich plasma treatment might be an option to promote faster healing after surgery.
Carpal Tunnel Syndrome Treatment Takeaway Message
Carpal tunnel syndrome is an extremely common condition that affects the wrists and hands, but there are still many misconceptions surrounding it. As you know now, carpal tunnel is not caused solely by computer use or typing. There are a variety of risk factors like repetitive motions, arthritis, and anatomical vulnerabilities.
Carpal tunnel syndrome is a complex condition. There are a diverse range of causes and solutions. Your treatment needs will vary depending on your specific case, and the effectiveness of different treatments varies. Fortunately, while carpal tunnel can be frustrating to live with, there are ways to successfully reduce symptoms and improve function, similar to conditions like tennis elbow or rotator cuff injuries.
Getting Carpal Tunnel Syndrome Treatment in Singapore
Whether you are dealing with minor wrist pain or debilitating symptoms, there is help out there! Why live in pain another day when you could be on your way to recovery? Our clinic also offers orthopaedic treatments for sports injuiry as well as meniscus tear surgery.
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About the Author
Dr James Tan is a highly skilled orthopaedic surgeon who has more than 10 years of experience in sports surgery and exercise medicine. He is a member of the elite Asian Shoulder and Elbow Group and a founding member of the Singapore Shoulder and Elbow Surgery Society.
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