Signs and Symptoms
Symptoms usually start gradually and come and go at first:
- Numbness, tingling or burning in the thumb, index, middle and part of the ring finger
- Symptoms that wake you at night or are present when you wake up, often relieved by shaking the hand
- Tingling while driving, holding a phone or reading
- Clumsiness or dropping objects
- In advanced cases, constant numbness and shrinking of the muscles at the base of the thumb
What Causes It?
Anything that crowds the carpal tunnel or irritates the nerve can cause symptoms. Often several factors combine:
- Swelling of the tendon linings that share the tunnel with the nerve
- Repetitive or forceful hand use and vibrating tools
- Diabetes, thyroid disease, rheumatoid arthritis and pregnancy
- A previous wrist fracture or arthritis that changes the shape of the tunnel
- Family history, age and being female
How We Diagnose It at POPB
Dr. Tucker will ask about your symptoms, check sensation and strength in your hand, and perform tests that press on or tap over the nerve to reproduce tingling. She will also check your neck and elbow, since a pinched nerve in those areas can cause similar symptoms.
X-rays in our office can look for arthritis or an old fracture. Diagnostic ultrasound can show swelling of the median nerve. A nerve conduction study and EMG (electrical tests of nerve and muscle function) may be ordered to confirm the diagnosis and show how severe the compression is, particularly before surgery.
Non-Surgical Treatment Options
Mild to moderate carpal tunnel syndrome often improves with non-surgical care:
- A wrist splint worn at night to keep the wrist straight and take pressure off the nerve. Elise Burger, OTR, our occupational and hand therapist, can fit you with a splint in our office.
- Hand therapy with Elise Burger for nerve and tendon gliding exercises and advice on changing how you use your hands at work and at home
- Activity changes, such as taking breaks from repetitive tasks and avoiding prolonged wrist bending
- A cortisone injection into the carpal tunnel, which can relieve symptoms for weeks to months and also helps confirm the diagnosis
Surgical Options
Surgery is recommended when symptoms are constant, when non-surgical care has not helped, or when testing shows significant nerve damage or muscle weakness. Waiting too long in severe cases can lead to numbness or weakness that does not fully recover.
Dr. Tucker performs carpal tunnel release, cutting the ligament that forms the roof of the tunnel to give the nerve more room. It is an outpatient procedure, usually under local or light anesthesia, and you go home the same day.
Recovery
After carpal tunnel release, you can usually use your hand for light tasks within days. Night symptoms often improve quickly, while numbness and strength may take weeks to months to improve, and longer if the nerve was severely compressed. Grip and pinch strength typically return over about 2 to 3 months. Many people return to desk work within 1 to 2 weeks and to heavy manual work in about 4 to 6 weeks, although timelines vary.
When needed, hand therapy with Elise Burger in our office helps with scar care, swelling and strength, and she shares your chart with Dr. Tucker.
Insurance and Cost
Office visits, X-rays, splints, hand therapy, cortisone injections, nerve testing and medically necessary surgery are generally covered by Medicare, most commercial PPO plans and workers' compensation, subject to your deductible and co-pay. HMO and managed-care plans require a referral from your primary care physician before the visit.
If your symptoms are related to your job, we coordinate care and handle workers' compensation documentation with your employer and carrier.
When to Be Seen
Make an appointment if numbness or tingling in your hand lasts more than a few weeks, wakes you at night regularly, or makes you drop things. See a physician promptly if numbness is constant or you notice weakness or wasting at the base of the thumb, because earlier treatment gives the nerve a better chance to recover.
