Carpal Tunnel Syndrome

What Is Carpal Tunnel Syndrome?

Carpal TunnelCarpal Tunnel 

Carpal tunnel syndrome is one of the most common problems that hand surgeons treat.

At the Yale Hand and Microsurgery Program, we offer surgical and non-surgical treatment for carpal tunnel syndrome, which includes the understanding and treatment of occupation-related disorders. In this program, our team of multidisciplinary specialists addresses problems developed in the workplace.  

The symptoms of carpal tunnel syndrome can be painful and the condition can be frustrating, because, if severe enough, carpal tunnel syndrome can inhibit even normal, everyday activities. 

Knowing the anatomy of the wrist may help you better understand your condition. The carpal tunnel is a space in the wrist that is formed by several structures. Bones make up three sides of the tunnel and a ligament runs across the top of this tunnel. Nine tendons and the median nerve travel through this space. The median nerve is one of the five main nerves originating from the brachial plexus. The tendons control the movement of the fingers while the median nerve supplies sensation to the thumb, index, middle and half of the ring finger. It also provides the ability of the thumb to move. If there is swelling in this space, the median nerve will be trapped against the ligament and become compressed. This compression is what causes the symptoms of carpal tunnel syndrome. 

Causes of Carpal Tunnel Syndrome

Carpal tunnel syndrome can be caused by anything that induces swelling within the carpal tunnel resulting in increased pressure on the median nerve. Carpal tunnel syndrome has been associated with: 

  • Trauma 
  • Tumors 
  • Rheumatoid arthritis 
  • Scleroderma 
  • Diabetes mellitus 
  • Pregnancy 
  • Gout 
  • Repetitive motion 

In many cases, the actual cause of this syndrome cannot be found, which can be frustrating to patients. However, not knowing the cause of your carpal tunnel syndrome does not usually affect the treatment or outcome. 

Our team at the Yale Hand and Microsurgery Program creates a custom and comprehensive treatment plan, including surgical and non-surgical care. An important component to your treatment plan is that our multidisciplinary specialists understand and address work-related stress to your carpal tunnel in order to prevent further and future irritation and injury.

Symptoms of Carpal Tunnel Syndrome

If you have carpal tunnel syndrome, you may experience some or all of the following symptoms: 

  • Numbness and tingling in the hand localized to the thumb, index, middle and half of the ring fingers (most common)
  • Numbness or tingling in the forearm or upper arm areas 
  • Weakness or clumsiness of the hand, especially when grasping small objects 
  • Profound weakness of the muscles at the base of the thumb

Symptoms of carpal tunnel syndrome are often worse at night; they may be severe enough to wake you from sleep. Carpal tunnel pain can also occur while performing routine daily activities. 

You may experience mild symptoms at first. Many people ignore the initial tingling or numbness they feel until the pain and symptoms worsen. But the sooner you are diagnosed, the better the chance of recovery without surgery.

If you think you may have carpal tunnel syndrome, our doctors can diagnose and assess the severity of your carpal tunnel syndrome. The severity of your carpal tunnel syndrome can be tested with an electrophysiologic study or a nerve conduction study. 

This list should be used as a guideline. Not every symptom is included. If you or a loved one has one or more of these symptoms, it does not mean that he or she has carpal tunnel syndrome. If you are concerned that you or a loved one might have carpal tunnel syndrome, please make an appointment with your doctor.

Treatments for Carpal Tunnel Syndrome

If you are suffering from carpal tunnel syndrome, it is normal to wonder if your condition will ever get better. Furthermore, you may find yourself overwhelmed by the idea that only surgery can help relieve your symptoms. It is important to know that treating carpal tunnel does not necessarily mean surgery. Depending on the severity of the problem, carpal tunnel syndrome can be treated in two basic ways. 

If you have a very mild case, your carpal tunnel treatment may include work modification, wrist splints, or anti-inflammatory medications to manage carpal tunnel pain and to help induce healing. It is important to minimize the activity that caused carpal tunnel syndrome in the first place. An integral part of our program is considering your lifestyle in order to help you discover which specific activities, whether at work or at home, have contributed to your condition. 

If you do not gain relief from non-surgical treatment of carpal tunnel therapy, or if you have a much more severe case of carpal tunnel syndrome, you may need surgery. Our surgeons, J. Grant Thomson, MD, FRCS, FACS, and Michael Matthew, MD, offer the latest techniques and specialized expertise while creating a treatment plan customized for you. At the Yale Hand and Microsurgery Program, you will be cared for by some of the country’s top specialists in hand and microsurgery.  

Carpal tunnel surgery can be performed in one of two ways, depending on which surgery would be best for your specific case: 

  • An endoscope, which is a small television camera with a light, can be inserted into the hand through a very small incision in the wrist crease. The ligament that lies over the carpal tunnel can be cut using this technique. 
  • In some patients, it is necessary to make an incision in the palm in order to release this ligament. 

Both surgeries are performed in an outpatient setting under local anesthesia. You can go home the same day.  

Dr. Thomson and Dr. Matthew have special interests in hand surgery, wrist surgery, carpal tunnel endoscopic surgery, microsurgery, and occupational disorders of the upper extremity.