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Have you ever been woken up in the middle of the night and your hands feel like they are numb or have a burning sensation? Almost as if you had sat on your hand for too long and now they have those “pins and needles” in them. If this sensation is getting worse over time, you may have carpal tunnel syndrome.

What is carpal  tunnel syndrome?

Carpal tunnel syndrome occurs when the median nerve is compressed near the level of the wrist. This usually occurs when the nerve is squeezed between the flexor retinaculum superficially, and the flexor tendons and carpal bones deep to the nerve. The nerve may become swollen and this leads to less available space within this compartment.

What are the signs and symptoms?

There are various signs and symptoms that can occur for those who have carpal tunnel syndrome. These include:

  • Numbness, tingling, burning, and pain located primarily in the thumb and index, middle, and ring fingers
  • Pain or tingling that may travel up the forearm toward the shoulder
  • Weakness and clumsiness in the hand
  • Dropping things, either due to weakness, numbness, or a loss of proprioception (awareness of where your hand is)
    Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers

Symptoms of carpal tunnel syndrome begin gradually, without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.

What causes carpal tunnel syndrome?

Most cases of carpal tunnel syndrome are caused by a combination of factors. These risk factors include:

  • Repetitive movements in the hand and wrist
  • Activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time

Health conditions such as diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome. Additionally, women who are pregnant may experience hormonal changes that can cause swelling which results in pressure on the nerve. Hereditary factors can also play a role, as some people may have a naturally smaller carpal tunnel, or there may be anatomic differences that change the amount of space for the nerve.

How is it diagnosed?

Carpal tunnel syndrome is usually diagnosed at a doctor’s office by history taking and a physical examination. Manual compression of the median nerve at the carpal tunnel may reproduce one’s symptoms. An ultrasound exam in the office and/or an MRI may be used to further evaluate the median nerve.

What treatment options are available?

Treatment for carpal tunnel syndrome usually consists of rest or taking breaks from the exacerbating activities (repetitive movements like typing). Additional treatments can include:

  • Using stiff wrist braces (mainly at night) and possibly more flexible wrist braces during the day
  • Hand physical therapy
  • Manual therapy
  • Injections, such as a nerve hydrodissection, in order to free up the nerve from surrounding structures and compression

If these treatments do not work, then surgery is usually an option.

Can you prevent carpal tunnel from happening?

Carpal tunnel syndrome is unpredictable, but one should try to avoid repetitive movements with their hands and wrists too often, take breaks from being on the computer, phone, and tablet, and routinely strengthen and stretch your upper extremity muscles.

Recommendations

I recommend taking frequent breaks from activities like typing and performing your stretches and strengthening exercises routinely.

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