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Zapped by Carpal Tunnel Syndrome

You notice a sudden electric feeling in your hand, or you wake up with tingly fingers. You wonder, “What could this be?” Most likely, it’s carpal tunnel syndrome (CTS).

CTS is a common condition affecting the hand. It is caused by excessive pressure on the median nerve in the carpal tunnel, the area where the hand and wrist meet at the base of the palm. Most common complaints are numbness, tingling, or an electric feeling in the palm side of the first four fingers (rarely the little finger). Symptoms are commonly noticed upon awakening, during the night, and when driving, reading or holding something, like a phone. When the condition gets severe, the small muscles in the palm near the base of the thumb can weaken and atrophy.

There are other nerve compression syndromes in the hand, arm, and even the leg, but carpal tunnel syndrome is the most widely known. CTS can occur at any age. It is three times more common in women than men and most common after age 30. Although it occurs in pregnant women, it usually goes away within three months after childbirth.

For many years keyboarding and computer use were thought to be a major cause of CTS. Recent scientific studies suggest that people who get CTS have some biologic predisposition for the condition, possibly based on a tendency to develop thickening of the material (called tenosynovium) that surrounds the nine tendons alongside the nerve in the carpal tunnel. Presently, no more is known about this tendency. Other causes of CTS are arthritis of the wrist joint, cysts inside the carpal tunnel, and anything that might take up space or narrow down the area inside the tunnel, such as swelling after a broken wrist.

TREATING CTS

Early diagnosis and treatment are important. Treatment with a wrist splint often controls CTS and is something you can try yourself. If it doesn’t work, you should consult your primary care physician, or a specialist like a hand surgeon or neurologist, because CTS can progress and cause permanent injury. Non-steroidal anti-inflammatory drugs, vitamin B-6, stretching and exercises are suggested, but don’t usually have lasting benefit. Steroid injections usually help, but often temporarily. Surgery is highly effective, if CTS is treated before serious nerve damage occurs.

Don’t delay—once permanent numbness or atrophy set in, outcomes are not as good.

Lewis B. Lane, M.D., is Chief of Hand Surgery, Dept. Orthopaedic Surgery, LIJ Medical Center and North Shore University Hospital and is an Associate Clinical Professor of Orthopaedics at Albert Einstein College of Medicine.

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