Do you often feel a numbness or tingling in your
hand, especially at night? Maybe you experience
clumsiness in handling objects and sometimes you feel
a pain that goes up the arm to as high as the
shoulder. These may be the symptoms of
The median nerve travels from the forearm into
your hand through a "tunnel" in your
wrist. The bottom and sides of this tunnel are
formed by wrist bones and the top of the tunnel
is covered by a strong band of connective tissue
called a ligament. This tunnel also contains
nine tendons that connect muscles to bones and
bend your fingers and thumb. These tendons are
covered with a lubricating membrane called
synovium which may enlarge and swell under some
circumstances. If the swelling is sufficient it
may cause the median nerve to be pressed up
against this strong ligament which may result in
numbness, tingling in your hand, clumsiness or
pain described above.
Anything that causes swelling, thickening or
irritation of the synovial membranes around the
tendons in the carpal tunnel can result in pressure
on the median nerve.
Some common causes and associated conditions are:
- Repetitive and forceful grasping with the
hands.
- Repetitive bending of the wrist.
- Broken or dislocated bones in the wrist
which produce swelling.
- Arthritis, especially the rheumatoid type.
- Thyroid gland imbalance.
- Sugar diabetes.
- Hormonal changes associated with menopause.
- Pregnancy.
Although, any of the above may be present, most cases have no known cause.
Your doctor may diagnose this condition by the
following symptoms and signs:
- Numbness and tingling in the hands,
especially when these symptoms occur at
night and after use of the hands.
- Decreased feeling in your thumb, index,
and long finger.
- The presence in your hand of an
electric-like shock or tingling (like
hitting your "funny bone") when
your doctor taps over the course of the
median nerve at the wrist.
- The reproduction of your symptoms by
holding your wrists in a bent down
position for one minute.
In some cases your doctor may recommend a special
test called a nerve conduction study. This test,
done by a specialist, determines the severity of the
pressure on the median nerve and may aid your orthopedic
surgeon in making a diagnosis and forming a
treatment plan.
Mild cases may be treated by applying a brace or
splint which is usually worn at night and keeps
your wrist from bending. Resting your wrist
allows the swollen and inflamed synovial
membranes to shrink; this relieves the pressure
on the nerve. These swollen membranes may also
be reduced in size by medications taken by mouth
called non-steroidal anti-inflammatories. In
more severe cases, your doctor may advise a
cortisone injection into the carpal tunnel. This
medicine spreads around the swollen synovial
membranes surrounding the tendons and shrinks
them, and, in turn, relieves the pressure on the
median nerve. The dosage of cortisone is small
and when used in this manner it usually has no
harmful side effects. The effectiveness of
non-surgical treatment is often dependent on
early diagnosis and treatment.
In those patients who do not gain relief from these non-surgical measures it may
be necessary to perform surgery. The site of the operation is made pain-free by
local anesthesia injected either into the wrist and hand or higher up in the
arm. This may be done by your orthopaedic surgeon or an anesthesia doctor. The
surgery itself is called a "release"-cutting the ligament that forms the roof of
the carpal tunnel to relieve the pressure on the median nerve. The surgery is
usually performed in an outpatient facility and you are generally not required
to stay over night.
Your doctor can explain to you the likelihood of non-surgical or surgical
treatment based on your own individual circumstances.
After surgery, your symptoms may be relieved
immediately or in a short period of time.
Tenderness at the incision site may persist
until healing is complete. Numbness may remain
for a period of time, particularly in older
persons or in more severe cases. It may be
several weeks before you can return to your
normal level of physical activities; for some,
it will be several months. You will probably be
given hand exercises to do to rebuild
circulation, muscle strength and joint
flexibility in your hand and wrist.
