Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition in which one of the body’s peripheral nerves is pressed on or squeezed. The condition can cause pain and changes in function and sensation in the wrist, forearm, and hand.

With broad and deep clinical experience, backed by current research and investigations conducted at UT Southwestern Medical Center, we are defining a wider range of effective nonsurgical and surgical treatment options for our patients. Our faculty members publish their work in high-impact scientific journals and present their work worldwide.

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome occurs when the median nerve is pressed or squeezed at the carpal tunnel. This nerve runs from the forearm into the palm of the hand through a narrow, rigid passageway of ligament and bones at the wrist.

The median nerve provides sensory and motor functions to the thumb and first three fingers. If it gets compressed or irritated, symptoms may develop, including numbness, weakness, or sometimes pain in the hand, wrist, and forearm.

What Causes Carpal Tunnel Syndrome?

It often results from a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. One or all of the following may be a contributing factor:

• Changes in blood sugar levels, as may be seen with Type 2 diabetes
• Development of a cyst or tumor in the canal
• Frequent and repetitive small movements with the hands, such as with typing or using a keyboard
• Frequent and repetitive grasping movements with the hands, such as with sports and certain other physical activities
• Frequent use of vibrating hand tools
• Joint or bone disease, such as arthritis, osteoarthritis, or rheumatoid arthritis
• Hormonal or metabolic changes, such as menopause, pregnancy, thyroid imbalance, or an overactive pituitary gland
• Other conditions or injuries of the wrist, including strain, sprain, dislocation, break, or swelling and inflammation
• Family history of carpal tunnel syndrome

None of these factors have been established as direct causes of carpal tunnel syndrome. While numerous studies have explored the association between computer use and carpal tunnel syndrome, there is not yet consistent evidence that clearly links extensive computer use with carpal tunnel syndrome.

What Are the Symptoms of Carpal Tunnel Syndrome?

Symptoms usually start gradually, appearing in one or both hands during the night. The dominant hand tends to have more severe symptoms.

They can include any of the following:

• Burning or tingling in the fingers, especially the thumb and the first two fingers
• Feeling the need to shake out the hand or wrist
• Pain or numbness in one or both hands
• Pain or numbness that is worse at night, interrupting sleep
• Pins-and-needles feeling in the fingers
• Swollen feeling in the fingers
• Weakness when gripping objects with one or both hands

In chronic or untreated cases, the muscles at the base of the thumb may waste away. Some people with very severe carpal tunnel syndrome have trouble feeling hot and cold by touch and might therefore burn their fingertips without knowing it.

The symptoms of carpal tunnel syndrome can be similar to other medical conditions or problems. It’s important to get a diagnosis from a physician to identify the most effective treatment.

How Is Carpal Tunnel Syndrome Diagnosed?

Diagnosis usually begins with a physical exam of the hands, arms, shoulders, and neck to check for movement dysfunction, atrophy, tenderness, swelling, warmth, and discoloration. In addition to a physical exam, other testing may be done, including:

• Routine laboratory tests and X-rays
• Electrodiagnostic tests, such as nerve conduction studies and electromyography, to determine the severity of damage to the median nerve
• Ultrasound imaging to check for abnormal size of the median nerve

How Is Carpal Tunnel Syndrome Treated?

UT Southwestern offers a team approach to treatment for carpal tunnel syndrome. A patient’s care team includes a peripheral nerve specialist as well as doctors and medical professionals in plastic surgery, neurosurgery, neurology, internal medicine, pain management, occupational therapy, physical therapy, and rehabilitation, as needed.

Each patient’s treatment plan is based on that person’s specific health conditions, needs, and goals.

Nonsurgical Treatments for Carpal Tunnel Syndrome

Nonsurgical treatments for carpal tunnel that can improve mild to moderate symptoms include:

• Anti-inflammatory medication or injection to reduce swelling
• Exercises to strengthen and improve mobility in the hands, arms, and shoulders
• Making changes to ergonomics at the worksite or location of other activities
• Splinting the affected hand, especially at night
• Alternative therapies such as yoga, acupuncture, and chiropractic care

Surgery for Carpal Tunnel Syndrome

Carpal tunnel release is one of the most common surgical procedures in the U.S., with a success rate of more than 90 percent. UT Southwestern surgeons make sure patients who are candidates for this surgery understand what to expect for recovery and whether physical therapy will be needed after surgery.

Carpal tunnel release surgery involves severing a ligament around the wrist to reduce pressure on the median nerve. This surgery is usually done under local or regional anesthesia and does not require an overnight hospital stay.

Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, involves making an incision in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel.

UT Southwestern also offers the latest minimally invasive procedures to release pressure on the median nerve, allowing for faster functional recovery and less postoperative discomfort than traditional open release surgery.

Follow-Up Care

Recovery from carpal tunnel surgery is different for each person. Although symptoms may be relieved immediately after surgery, full recovery from the procedure can take months. Recurrence of carpal tunnel syndrome following treatment is rare, but some residual numbness or weakness is common, especially if the carpal tunnel syndrome had become severe.

UT Southwestern surgeons make sure patients are prepared for postoperative care and physical therapy so the results of the surgery are as positive as possible.