Carpal Tunnel Syndrome

There is often no single cause. Most cases come from a mix of factors that add pressure inside the carpal tunnel:

• Repetitive hand and wrist motion, especially with the wrist bent, such as assembly work, typing or using vibrating tools
• Wrist anatomy, including a naturally smaller carpal tunnel or a past wrist fracture
• Health conditions such as diabetes, rheumatoid arthritis, thyroid disorders and obesity
• Fluid retention, which is common during pregnancy and menopause
• Age and sex: it is more common in adults over 40 and in women

Symptoms usually start slowly and may come and go at first. Common signs include:

• Numbness, tingling or burning in the thumb, index, middle and part of the ring finger
• Symptoms that wake you up at night or are worse in the morning
• Shaking out your hand to get relief
• Weak grip or dropping things
• Trouble with fine tasks like buttoning a shirt
• Pain or tingling that travels up the forearm

If numbness becomes constant or you notice shrinking muscles at the base of your thumb, see a hand specialist soon. These can be signs of more serious nerve compression.

Your hand specialist will start with a conversation about your symptoms and a physical exam of your hand, wrist and arm. Your provider may:

• Tap over the median nerve or bend your wrist to see if symptoms appear
• Check feeling in your fingers and strength in your hand
• Order X-rays to rule out arthritis or a fracture
• Recommend a nerve conduction study to measure how well the median nerve is working

Treatment depends on how severe your symptoms are and how long you have had them. Many patients improve without surgery, especially when treated early.

Nonsurgical treatment

• Wearing a wrist splint at night to keep the wrist straight
• Changing activities that make symptoms worse and taking breaks from repetitive tasks
• Anti-inflammatory medication to ease discomfort
• A corticosteroid injection to reduce swelling around the nerve
• Hand therapy exercises

Surgical treatment

If symptoms do not improve or nerve damage is a concern, your surgeon may recommend carpal tunnel release. This outpatient procedure cuts the transverse carpal ligament to make more room for the nerve. Most patients go home the same day.

Recovery is different for everyone, but many patients notice relief from nighttime symptoms soon after surgery. You can usually use your hand for light tasks within a few days. Grip strength and pinch strength often take several weeks to a few months to fully return. Your surgeon will give you specific instructions for wound care, activity and returning to work.

Will carpal tunnel syndrome go away on its own?
Mild symptoms sometimes improve with rest and a night splint. Symptoms that last or keep getting worse should be checked by a hand specialist.

Do I need surgery for carpal tunnel?
Not always. Many patients do well with splinting, activity changes or an injection. Surgery is usually recommended when these do not help or when there are signs of nerve damage.

When should I see a doctor for hand numbness?
See a specialist if numbness or tingling wakes you at night, lasts more than a few weeks, or comes with weakness.

Where can I be seen?
Our hand specialists see patients in Tacoma, Lakewood and Gig Harbor. Call (253) 830-5200 to schedule.