Carpal Tunnel Syndrome

Diagnosis

To diagnose carpal tunnel syndrome, your healthcare provider will review your symptoms and perform specific tests to confirm the condition.

History of Symptoms

The pattern of your symptoms plays a key role in diagnosis. Carpal tunnel syndrome symptoms commonly appear when holding a phone, reading a newspaper, or gripping a steering wheel. They often occur at night, waking you from sleep, or may be noticed upon waking in the morning.

Because the median nerve does not affect the little finger, symptoms in that finger may suggest a condition other than carpal tunnel syndrome.

Physical Examination

Your healthcare professional may test the feeling in your fingers and the strength of your hand muscles. Simple actions such as bending the wrist, tapping on the nerve, or pressing on it can reproduce symptoms and help confirm the diagnosis.

Imaging and Diagnostic Tests

• X-ray: Used to rule out other causes of wrist pain such as arthritis or fractures. However, X-rays alone do not confirm carpal tunnel syndrome.

• Ultrasound: Provides an image of the tendons and nerves in the wrist to check for nerve compression.

• Electromyography (EMG): Measures the electrical activity in muscles using a thin-needle electrode. This test can detect nerve or muscle damage and rule out other conditions.

• Nerve Conduction Study: In this test, two electrodes are placed on the skin, and a small electrical pulse is passed through the median nerve. Slowed nerve signals can confirm carpal tunnel syndrome.

Treatment

Early treatment is essential to prevent permanent nerve damage. In the initial stages, simple self-care steps can relieve symptoms, such as taking frequent breaks, avoiding activities that worsen symptoms, and using cold packs to reduce swelling.

If symptoms persist, treatment may include splinting, medications, or surgery depending on the severity of the condition.

Nonsurgical Therapy

When diagnosed early, nonsurgical treatments can significantly improve symptoms.

• Wrist Splinting: Wearing a splint at night keeps the wrist still and relieves nighttime tingling or numbness. This method is especially effective for pregnant individuals as it avoids medication use.

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications such as ibuprofen may help reduce pain temporarily, but they do not treat the underlying condition.

• Corticosteroid Injections: Injections of corticosteroids like cortisone directly into the carpal tunnel can relieve pain and inflammation. Ultrasound guidance may be used to ensure accurate delivery. Oral corticosteroids are less effective than injections.

If carpal tunnel syndrome is linked to rheumatoid arthritis or another inflammatory condition, treating the underlying disease may help reduce symptoms.

Surgery

Surgery may be recommended when symptoms are severe or do not improve with conservative treatment. The goal of surgery is to relieve pressure on the median nerve by cutting the ligament that forms the roof of the carpal tunnel.

Common surgical techniques include:

• Endoscopic Surgery: A surgeon uses a small camera (endoscope) to view inside the carpal tunnel and cut the ligament through tiny incisions. This approach often results in less postoperative pain.

• Open Surgery: A larger incision is made in the palm to cut the ligament and free the nerve.

• Ultrasound-Guided Surgery: The surgeon uses ultrasound imaging to view the structures in the wrist and cuts the ligament using a small knife or braided wire.

Discuss the potential risks and benefits of each method with your surgeon. Possible complications include incomplete ligament release, wound infections, scarring, and nerve or blood vessel injury.

During recovery, the ligament tissue gradually heals while leaving more space for the nerve. The skin typically heals within a few weeks, but internal recovery may take several months. Gradual return to normal hand use is advised, avoiding forceful motions and extreme wrist positions.

Mild soreness or weakness can last for weeks to months after surgery. In severe cases, symptoms may not completely resolve even after surgical treatment.