If you have numbness, tingling, and pain in your hands and forearms, you may have carpal tunnel syndrome. You may notice shock-like sensations and weakness in the hand. You may drop items and notice a decrease in your grip strength or problems buttoning your shirt or fastening a necklace. You may detect the hand pain worse at night, possibly waking you up. The symptoms may be noticeable when driving, talking on the phone, or reading a book. You may find moving or shaking your hand to relieve the symptoms temporarily. If you have carpal tunnel syndrome, your symptoms will worsen over time and may start to affect your quality of life.
The median nerve supplies sensation to the thumb, index, long, and ring fingers. When this nerve gets squeezed or compressed, it can cause pain, numbness, and tingling. This can even radiate through the hand, wrist, and forearm. Symptoms that come and go are not as problematic as symptoms that become constant. Prolonged compression of any nerve can cause irreversible damage and functional problems.
See your primary care provider if you have these symptoms. Generally, night-time bracing can relieve mild symptoms. You can also avoid activities that aggravate your symptoms. Sometimes a steroid injection in the carpal tunnel can also improve symptoms, and an anti-inflammatory such as Advil, Aleve, or Ibuprofen. Unfortunately, these treatments do not improve symptoms for everyone.
Your physician may order Electrophysiological tests (nerve tests) that determine if the median nerve is working and if there is too much pressure on the nerve. If the tests show constant pressure on the nerve, you will then be referred to Orthopedics for further evaluation and to discuss a surgical procedure. The procedure is called a carpal tunnel release. This surgery relieves the pressure off the nerve, restoring blood flow to and function of the nerve.
The surgical release itself is a short-timed procedure requiring a small incision. This procedure is done as an outpatient (in and out of the hospital on the same day). Recovery includes ice, elevation, gentle finger range of motion to help decrease swelling, stiffness, pain, and activity modification (no heavy lifting) for a minimum of 2-3 weeks. Minor soreness in the hand is expected and can last a few weeks to a few months. In time, the sensation in the hand is restored. In mild cases, the sensation can be restored immediately after surgery, and in more severe cases, the improved sensation is noted 6-12 months after surgery. In very severe cases, some patients may never have average sensation return, but surgery can prevent the condition from getting worse.
With any surgical procedure, there are complications of bleeding, infection, poor wound healing, nerve aggravation, or injury. Most patients will see improvement after carpal tunnel release. Recovery is gradual and complete recovery could take up to a year. Rarely, carpal tunnel syndrome can recur and may require additional treatment or surgery.
If you have noticed pain, numbness, and weakness in your hand(s), call your primary care provider for evaluation, specifically if your symptoms have progressed from mild, intermittent to severe and constant. Early diagnosis and treatment will often provide a better overall outcome and quality of life.
