The sooner carpal tunnel syndrome is diagnosed and treated, the better the chances for symptom relief, according to experts at Hospital for Special Surgery (HSS) in New York City. Unfortunately, some people go undiagnosed for years, and by the time they see a doctor, it's more difficult to reverse the damage.
"When you think of carpal tunnel syndrome, it often brings to mind someone working on a computer keyboard and wearing a wrist splint. In reality, it can affect just about anyone," says Dr. Daniel Osei, a hand surgeon at HSS who has seen the condition in adults of all ages, with all kinds of jobs. Symptoms can range from relatively mild to quite severe and include pain, numbness, tingling and weakness in the hands and fingers. In many cases, it's difficult to pinpoint a specific cause.
The condition arises from too much pressure on the median nerve - one of the main nerves in the hand that travels from the forearm to the palm through a narrow passageway in the wrist known as the carpel tunnel. The compression of this nerve causes symptoms. It usually affects the thumb, index, middle finger and ring finger. Sometimes the pain travels up the arm. Women are affected two to three times as often as men, and many people experience symptoms in both hands.
"It's not uncommon for me to see patients who've had subtle pressure on their median nerve for decades, but the symptoms previously weren't severe enough for them to pay much attention," he says. "When the condition goes on for that long and is finally diagnosed, it's more difficult to restore normal hand function."
In advanced stages, people can lose feeling in their fingers, experience severe weakness in their hands and lose grip strength. They may feel clumsy and start dropping things; their handwriting may have gotten worse; they're no longer able to button a shirt; they have trouble picking up coins or a glass of water.
Fortunately, most patients don't get to that point. One of Dr. Osei's patients, who received a timely diagnosis and treatment, described her symptoms: "My fingers were getting numb and tingly, and my forearm hurt, especially at the end of the day. Sometimes it felt like I had stuck my finger in a light socket. The pain even went up my arm into my shoulder. It was really, really uncomfortable and very hard to sleep."
Her medical history, physical exam, and EMG testing, which measures the electrical activity of nerves and muscles, confirmed the diagnosis of carpal tunnel syndrome. Other conditions were also ruled out. Her first line of treatment included wearing a splint and receiving a cortisone injection, which helped.
She ultimately opted for surgery to seek permanent relief. A common outpatient procedure, it entails removing the "roof" of the carpal tunnel to make more space and relieve pressure on the nerve. Hand surgeons do this by cutting a ligament in the wrist through a one-inch incision. The procedure takes about a half hour and is performed under local anesthesia. Just one week after surgery, she said her hand was feeling better.
"With timely diagnosis and treatment, we find that there's a high level of patient satisfaction," Dr. Osei notes. "The pain often gets better quickly after surgery, and symptom relief is expected to be long-lasting."
It's more challenging to reverse damage in patients who've gone undiagnosed for an extended period, according to Dr. Osei. Over time, pressure on the median nerve causes muscles at the base of the thumb to waste away. This in turn causes weakness, leading to a loss of grip strength. People generally don't notice that their hand looks different due to muscle atrophy until the doctor points it out to them.
Once an individual starts losing grip strength, surgery is often considered so the damage and disability don't get worse. Without treatment, normal activities of daily living can become increasingly difficult as the nerve and muscles deteriorate further. The ability to bathe, to get dressed and to use utensils may be affected, and quality of life will suffer.
"For these patients, surgery will relieve the pain and prevent carpal tunnel syndrome from causing additional damage," says Dr. Osei, "although the loss of sensation and numbness in their fingers will likely take some time to get better."
Risk Factors for Carpal Tunnel Syndrome
While anyone can develop carpal tunnel, it's more likely to occur if there's an injury or other medical condition that causes pressure on the median nerve. People who have diabetes, an underactive thyroid, a disease that causes inflammation such as rheumatoid arthritis, or a very small wrist are at greater risk. Frequent use of a computer keyboard, manual labor and other repetitive activities using one's hands can make carpal tunnel worse. There's no firm evidence that texting causes it, but it can exacerbate symptoms in susceptible individuals, according to Dr. Osei.