What is carpal tunnel?

It’s a term that many people hear and attribute to several different issues. A person may have hand or wrist pain and will say, “Oh, I have carpal tunnel.” But what is carpal tunnel syndrome really?

The main issue with carpal tunnel is that the nerve in your palm that feeds the feeling to three and half fingers gets compressed. Typically, the symptoms of carpal tunnel syndrome are numbness and tingling.

The carpal tunnel basically looks like a box. The bottom and sides of the box are made up of your wrist bones, and those are static. They don’t move. On top is a ligament that goes across the box. And in the middle of the box is the nerve that controls the feeling in your fingers. Over time, that ligament can thicken and press down on the nerve underneath it.

The nerve goes through the same space that all the tendons that bend your fingers go through. So, if you do a lot of repetitive movements, the tendons become inflamed or swollen, and that can also irritate the nerve and cause similar symptoms.

In a sense, carpal tunnel syndrome and tendonitis go together, but usually carpal tunnel is what we refer to as the nerve symptoms. It is a very common condition. There are over 200,000 cases per year, and in the past it has been the second most common cause of days lost from the workplace. People would miss on average between three to four weeks due to carpal tunnel syndrome.

There are a lot of different risk factors for developing this condition. Most of the time, we aren’t 100% certain what causes it, but there are certain jobs or occupational factors that come into play. For example, using jackhammers or anything that requires a lot of repetitive hand motions. Pregnancy, older age, female gender, family history, diabetes, or rheumatoid arthritis can also be associated with carpal tunnel syndrome.

When do you make an appointment with a physician for carpal tunnel syndrome?

Basically, if your hand doesn’t feel good, and you’ve tried to manage the symptoms but it still hurts, you should make an appointment with a hand physician. There are a lot of different things that can cause your hand to not feel well, and it may very well be carpal tunnel syndrome. The most common symptom that people present with is numbness and tingling. A lot of people will say when they’re driving, their hand falls asleep. When they’re using their phone, their hand falls asleep. Or if they’re holding up their phone to talk on it, they feel a pins and needles sensation.

Many patients come into the office because they wake up in the middle of the night with pain. It takes a while for their hand to wake up, and it feels very, very stiff. You may drop things or have difficulty buttoning your shirt. If you’re trying to perform fine motor skills, you may struggle due to your fingers feeling numb.

There are a lot of different treatment options for carpal tunnel. Simple ones that we start out with are anti-inflammatory medications. Night splinting is another option that we heavily recommend. Primarily, we advise people to wear the splint at night because at night your wrist bends which pinches off your nerve even more. Also, with more and more people working from home, the symptoms of tendonitis and carpal tunnel are rising due to at-home workstations being improperly set up. People are using their laptop on their couch instead of a desk for instance.

There are many different exercises and positional factors that you can consider trying to help relieve those symptoms. On the more invasive side, you can receive injections or have surgery. Surgery is not always the only solution, so if you are coming into the office to have your hand examined, don’t immediately think you will need surgery to correct it.

To recap and summarize, remember the following.

  • Make sure your workstation is ergonomically friendly.
  • If your symptoms just started within the last few months since working from home, make sure your wrists are in good positions while working. They should not be tense or overextended all day long.
  • Take time to do wrist exercises in the middle of the day.
  • Symptoms can come and go. When they flare up, take anti-inflammatories, wear your braces, and do your exercises.
  • If after all of these measures the symptoms don’t go away, then come into the office, and we’ll take care of you

Frequently asked questions

Does night splinting help?

Night splinting does help the vast majority of patients.

In the middle of the night, people’s wrists tend to bend down which pinches off that nerve even more. The splint puts your wrist in a more neutral position and allows that nerve and the surrounding tendons to rest in a neutral position. That usually makes people feel much better during the daytime.

Using the regular mouse and keyboard hurts my hand. Is there anything I can do about that?

Everyone is a little different, but some patients have reported that using the vertical mouse can be very helpful. With the vertical mouse, you’re able to rest your wrist in a more neutral position.

Laptop keyboards are probably the worst. Full-size regular keyboards are much better because you can put the keyboard farther away from you or have your wrists in a more neutral position. I tell patients to put a support under their forearm to help keep their wrists in that neutral position. Sometimes, wearing your brace during the day can be helpful until you have found that position where your wrist is not too bent or extended. After you’ve found that position, you can take the brace off.

If you do have to get surgery for carpal tunnel syndrome, what is the typical recovery time?

About two to four weeks.

We want to let the skin heal, and because the procedure is a release, there is nothing internally that needs to heal. People are able to use their fingers right away and use their hands for light activities.

We want to avoid heavy gripping and lifting during that two to four week timespan.

What are some exercises to help relieve carpal tunnel?

The main exercises that people do are intrinsic stretches and tendon gliding exercises. Essentially, these exercises stretch the little muscles in your hand and put your tendons through a full range of motion, which can affect the pinched nerve also. These exercises help your tendons move better.

We have amazing hand therapists here at OrthoVirginia who can take you through those exercises or give you a home exercise program.

I just received my COVID-19 vaccine. When is it safe to get a shot for my carpal tunnel syndrome?

There are different recommendations coming out on that right now. The one we are using is not within 10 days before or after receiving the COVID-19 vaccine. There obviously have not been any strong studies done on this, but this recommendation is what is coming out of the hospitals.

Can carpal tunnel reoccur?

It can.

The surgery is to release the ligament. Basically, what you do is cut the ligament on one side, and it opens up like a trap door. Over time, that can scar back down and thicken again. Typically, true recurrence tends to happen after a few decades. I’ll see patients after 20 or 30 years, and the internal scarring is pressing down on the nerve again.

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