Think You Might Have
Carpal Tunnel Syndrome?

Could your thumb and finger joint pain be related to carpal tunnel syndrome? Not all pain and numbness of the hand and thumb is carpal tunnel related. Learn more about this condition, other possible causes of your pain, and what can be done to reduce your symptoms.




What is the Carpal Tunnel?

The carpal tunnel of the hand is formed by the transverse carpal ligament as it connects between carpal bones of the hand. The median nerve travels through this tunnel to innervate the muscles of the thumb and hand. In addition to the median nerve, tendons that work to flex the wrist and fingers also pass through this tunnel. Carpal tunnel is the condition in which the median nerve becomes pinched or compressed within this tunnel.

Carpal tunnel syndrome


Typical Causes of Carpal Tunnel Syndrome

Typically, symptoms related to pressure of the median nerve occurs secondary to inflammation of the flexor tendons. Although this irritation is most commonly associated with overuse, such as repetitive typing, there is limited evidence that repetitive activity directly causes carpal tunnel.

Mechanical issues can be a contributing factor including wrist trauma such as sprains and the use of vibration tools such as a jack hammer. Night time pain can also be associated with thumb and hand positions. When sleeping, if the wrist is maintained in a sustained flexed position, pinching of the median nerve can occur.

Symptoms involving compression of the median nerve most often are related to a number of factors. Women are three times more likely to have carpal tunnel. Another aspect is that some people are simply born with a narrowed tunnel, making it easier for the nerve to become compressed. Other factors including water retention (such as during pregnancy), an overactive pituitary gland, repeated use of vibratory equipment, rheumatoid arthritis , and hypothyroidism can all be potential contributors. Unfortunately, sometimes there is not a known cause.


Typical Symptoms of Carpal Tunnel Syndrome

Being that carpal tunnel syndrome involves pinching of a nerve, symptoms are neurological in nature. Complaints generally include numbness, tingling, burning, pain, and weakness. The median nerve supplies sensation and muscle activity to the palm side of the thumb and first and second fingers and half of the ring finger, thus symptoms occur in these areas. With significant cases, atrophy of the muscles of the pad of the thumb (called the thenar eminence) can occur. Weakness can also affect the pincer grip between the thumb and first finger.

Because of the neurological nature of this condition, it is possible for the symptoms to come for other sources including the cervical spine and even elbow. If you have symptoms that extend above your hand and wrist, insist your doctor do a thorough evaluation to determine the true source of the symptoms. True carpal tunnel symptoms will only radiate from the wrist down to the thumb and fingers. Symptoms will not radiate up toward the elbow.

A number of tests are used to help diagnose carpal tunnel. Phalen’s test is a maneuver in which the back of the hands are pushed against each other and held for one minute. If symptoms of carpal tunnel are reproduced, the test is positive.

phalens test


Another test is called Tinel’s. This test involves tapping the base of the wrist at the carpal tunnel to see if the median nerve is irritated. A positive test is reproduction of pain or neurological symptoms.

One of the more common diagnostic tests to help determine the source of the symptoms is a nerve conduction test. This test involves sending electronic impulses down a nerve path in order to see if and where the nerve may be getting pinched. Before surgery is discussed, these test results must be thoroughly evaluated.



Conservative Treatment Protocol

As inflammation of the local tendons can contribute to carpal tunnel symptoms, reducing the inflammation is a treatment goal. Anti-inflammatory medications and creams are frequently prescribed by doctors for this condition. Another treatment recommendation with good results is vitamin B-6. Although effective, the mechanism of how it is works is still unclear. When oral medications or supplements are not effective, cortisone injections are generally recommended.

In addition to medications, the use of ice therapy can help in reducing local inflammation. Because of the neurological nature of carpal tunnel, if the use of ice increases local pain and tingling, minimize ice time from 10 minutes to 5 minutes.

Central to the treatment of symptoms is limiting aggravating activities. If typing is the central aggravator, the use of ergonomic accessories with typing will minimize stress on the nerve. The use of a keyboard cushion improves the wrist angle. As gripping between the thumb and first finger can become weak, the use of writing instruments with a greater diameter can be helpful.

In cases of significant pain and specifically if night time symptoms occur, the use of wrist splint is recommended. The splint helps to keep the wrist in a neutral position, avoiding compression of the tunnel.

wrist splint

Physical Therapy

Typical physical therapy treatment for carpal tunnel syndrome can include modalities, soft tissue massage, and exercise. The goals for therapy are to improve soft tissue mobility, flexibility, and restore strength.

Typical modalities used in physical therapy can include ultrasound, ice therapy, and iontophoresis. Ultrasound works by helping to increase tissue temperature and promote healing. Another type of ultrasound called phonophoresis can also be used. This type of ultrasound utilizes a gel that has an anti-inflammatory medication mixed in it to help in reducing inflammation. Iontophoresis is another modality that utilizes anti-inflammatory medication but utilizes electrodes to help administer the medication.

Restoring flexibility of the muscles of the wrist and fingers is another aspect of treatment. Flexibility and stretching exercises should not reproduce symptoms. As symptoms improve, restoring strength of the muscles of the thumb and hand will be part of the return to full function.


Surgery

Research has indicated that conservative treatment is generally successful in treating mild and moderate symptoms. However, in cases when cases are severe symptoms are present and conservative treatment has failed, carpal tunnel surgery is the best choice.


Summary

• Carpal tunnel syndrome occurs when the median nerve becomes pinched within the carpal tunnel.

• Symptoms can include pain, numbness, and weakness in the thumb and first two fingers.

• For mild and moderate symptoms, conservative treatment including anti-inflammatory medication, B-6 supplementation, minimizing aggravating activities, wrist splinting, and physical therapy can be effective.

• For severe symptoms, carpal tunnel surgery is often recommended.

Carpal tunnel syndrome can be an aggravating and limiting condition. Don’t let these symptoms control you. Be consistent with following the recommendations and relief can be yours.




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Return from Carpal Tunnel Syndrome to Hand Joint Pain

References

Arch Phys Med Rehabil. 2012 Jan;93(1):1-10.The comparative effectiveness of combined lumbrical muscle splints and stretches on symptoms and function in carpal tunnel syndrome.Baker NA, Moehling KK, Rubinstein EN, Wollstein R, Gustafson NP, Baratz M.

Hand (N Y). 2010 Dec;5(4):354-60. Epub 2010 Mar 23.Is there Light at the End of the Tunnel? Controversies in the Diagnosis and Management of Carpal Tunnel Syndrome.Prime MS, Palmer J, Khan WS, Goddard NJ.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 May;25(5):628-30.Research progress of treatment of carpal tunnel syndrome.Feng S, Gao S.