Carpal Tunnel Syndrome

Let the experts at Hoag Orthopedic Institute Help

Do I have Carpal Tunnel?

Carpal tunnel, or median nerve compression, is a numbness, tingling or weakness in the hand and arm caused by a pinched nerve or pressure on your median nerve. Carpal tunnel can be caused by over-use or repetitive motions (like typing) and is more commonly seen in women (3:1). Carpal tunnel is caused by a lack of space and blood flow to the median nerve area causing numbness and radiating pain in the hand, wrist and forearm area. Over time, carpal tunnel can also affect hand strength and ability to grasp things with the hand effectively. This can affect your ability to do daily activities.

There is a higher incidence of having carpal tunnel as we age, peaking in patients that are 50 or 60 years of age. There is also a strong correlation with patients that have a higher body mass index (BMI). Other risk factors include: Diabetes, hyperthyroidism, rheumatoid arthritis and pregnancy.

Symptoms of Carpal Tunnel

Carpal tunnel causes numbness and pain in the hand, wrist and forearm area. If you are experiencing some of the symptoms below, please contact a hand surgeon at Hoag Orthopedic Institute and schedule an appointment.

• Numbness and tingling in the hand (median nerve sensory distribution)
• Pain radiating in the hand, wrist and up the arm
• Symptoms worsen with increased activity (causing increased pressure to the median nerve)
• Decreased fine motor skills in the hand and wrist (difficulty buttoning a shirt or opening a jar)
• Weakness in your hands, difficulty holding things
• Cold intolerance, dryness, and unusual textures in the fingers (radial digits) signify disruption of the sympathetic fibers carried by the median nerve
• Pain worsens during sleep

Why does carpal tunnel pain worsen during sleep?

• During sleep we often flex our wrist, which increases pressure on the median nerve
• Blood Pressure decreases during sleep, causing poorer nerve perfusion
• Due to the inactivity during sleep, we are no longer “pumping” fluid out of the wrist

Diagnosis of Carpal Tunnel

When you come to Hoag Orthopedic Institute (HOI) for a physical exam, your hand doctor will consider many factors before diagnosing carpal tunnel, including how your symptoms developed.

During your physical exam, your orthopedic doctor will use a variety of diagnostic tests to pinpoint what exactly is causing your hand and arm pain, including:

• Observation for thenar atrophy (late)
• Sensory testing
• Motor testing (APB muscle)
• Provocative testing via media nerve compression
• Electrodiagnostic studies
• Phalen’s test of wrist flexion
• Tinel’s test (recreates tingling sensation in the sensory distribution of the median nerve)
• Compression test (a positive test recreates tingling or numbness within 30 seconds in the median nerve distribution)
• Nerve test (Electromyogram EMG) directly records from the muscles and measures severity of nerve dysfunction

Non-Surgical Carpal Tunnel Treatment

The goal of treating hand and wrist pain caused by carpal tunnel is to effectively decrease pressure and improve blood flow to the median nerve. The following non-surgical treatments can help alleviate this pressure.

• Night-time splint: keeps the wrist in a neutral position to help prevent wrist flexion during sleep
• Vitamin B6: 100mg – 200mg once a day
• Steroid injections decrease inflammation and swelling and can relieve pressure and improve blood flow to the median nerve

Surgical Carpal Tunnel Treatment

Since continued carpal tunnel can result in permanent nerve damage, if conservative treatments do not relieve your hand and wrist pain your hand surgeon may recommend carpal tunnel surgery. Carpal tunnel surgery increases the space surrounding the media nerve by sectioning the transverse carpal ligament and opening up the volar aspect of the carpal tunnel. Options for carpal tunnel surgery include:

• Open Release Carpal Tunnel surgery
• Endoscopic directed release carpal tunnel surgery
• Minimal incision release carpal tunnel surgery

Schedule a consult today with a hand surgeon to determine the best treatment option for your specific case.

What to expect from Open Release Carpal Tunnel Surgery?

Since the open release method for carpal tunnel surgery has a 95% or higher success rate¹, let’s discuss w what you can expect from this procedure.

• 30-minute surgery at an outpatient surgery center
• Less than a 1-inch incision
• 2-3-week recovery
• May use your hand gently immediately following surgery

Find a Hand Surgeon

Our Board-Certified, fellowship-trained hand surgeons are experts at treating carpal tunnel. Hoag Orthopedic Institute is ranked as one of the top Orthopedic Hospitals by U.S. News & World Report in 2020-2021. Contact Hoag Orthopedic Institute today to schedule a consultation with one of our hand doctors.

Find a hand surgeon that treats carpal tunnel.
Call us at (949) 705-6493 to make an appointment.

Source: ¹ NCBI – Carpal Tunnel Syndrome