You’ve Got Your Nerve
Tingling fingers? Aching wrists? These symptoms could result from pressure on the median nerve in your arm and wrist—carpal tunnel syndrome.
Raise your hand if you’ve been guilty of playing too much Candy Crush Saga or scrolling TikTok for hours before bed. Now, how many of you are feeling numbness or tingling in that hand?
In our increasingly digital world, hand and wrist discomfort has become a familiar issue. If this problem affects you, you may be one of the 10 million U.S. residents who, according to the American Medical Association, suffer from carpal tunnel syndrome (CTS). The condition is brought on by pressure on the median nerve, which runs from the forearm into the hand. This nerve passes through a narrow space in the wrist called the carpal tunnel. When the tunnel narrows or nearby tissues swell—often from overuse or inflammation—the nerve becomes compressed, resulting in pain, tingling or numbness in the hand and fingers.
Long considered a condition that affected mostly office workers, CTS actually can plague almost anyone who plays sports, works with power tools, drives a car—or does just about any protracted or repetitive daily activity involving arms, wrists or hands.
Feel the pain?
The median nerve carries signals for sensation and muscle movement. When the median nerve is compressed or entrapped, it cannot function properly.
Repetitive hand movements are one of the most common triggers of CTS. Long hours spent typing, texting or using a computer mouse can gradually strain the wrist, especially when posture and ergonomics are poor. But jobs and activities involving assembly lines, handheld tools and machinery with constant vibrations can have a similar effect. Even pregnancy can lead to temporary CTS, as fluid retention can increase pressure in the carpal tunnel.
The primary symptoms of carpal tunnel syndrome are pain, numbness and tingling. The numbness and tingling are typically present in the thumb, index finger, middle finger and half of the ring finger. Some people may describe the pain as a deep ache or burning. Other symptoms may include pain radiating into your arms, weak and clumsy feeling in thumbs, difficulty grabbing items. In addition, symptoms may be more pronounced at night, when you perform certain activities or in cold temperatures.
Nighttime pain is common, as many people sleep with their wrists either bent upward or downward, positions that exert increased force on the nerve.
What can be done
To diagnose CTS, a doctor will usually begin with a physical examination and nerve tests, checking for signs like weakness in the hand or a delayed response in sensation. Specific tests, such as the Tinel’s sign (in which the doctor taps on the nerve) or Phalen’s maneuver (which involves bending the wrists to see if it reproduces symptoms), are commonly used. In some cases, physicians may use nerve conduction studies to measure how well the median nerve works and to help determine the site of compression. In addition, lab tests may be ordered if your doctor suspects a medical condition that is associated with carpal tunnel syndrome, such as hypothyroidism or diabetes.
Whether or not you experience symptoms, our expert urges preventive measures: Take frequent breaks from work or repetitive tasks and shake out your hands, which can relieve any pressure from the nerve. For those who use a computer, use a wrist rest with the keyboard and mouse in order to keep the wrist in a neutral position. Splints may also be worn during activities that aggravate your symptoms to position the wrist properly and provide wrist support. Your doctor may suggest over-the-counter, anti-inflammatory medication to help reduce your pain and swelling. Sometimes doctors choose to inject corticosteroid medication, an anti-inflammatory medication, to provide symptom relief.
Some medical professionals, such as Maria Choy, M.D., a neurologist with Central Jersey Neurological Institute in Matawan, also practice forms of integrative medicine and may recommend acupuncture to alleviate CTS patients’ pain. Acupuncture works by releasing natural chemicals in our body called neurotransmitters. Among these chemicals are endorphins, the body’s natural pain relief mechanism. About 80 percent of the patients who try acupuncture for this purpose will have pain relief—but it’s not a cure for carpal tunnel.”
When nonsurgical options aren’t effective, carpal tunnel release surgery may be considered. According to the Central Jersey Neurological Institute website, the standard surgery for carpal tunnel syndrome is called an open release. For this procedure, the surgeon makes a two- to three-inch opening along the palm and an incision in the transverse carpal ligament to open the tunnel and make it larger. Doing this takes pressure off the median nerve. The surgery time is short, only about 15 minutes.
The course of treatment depends on the individual, as CTS can affect people in different ways. While CTS-related pain or discomfort originates at the wrist, it can radiate up the arm or even into the shoulder, mimicking conditions like tennis elbow or rotator cuff issues. That’s why it’s key to have a proper diagnosis and treatment: You wouldn’t want to be trying home remedies on your shoulder or upper arm when the source of the problem is in the wrist.
