Ask a Doctor: Carpal Tunnel Syndrome

Dr. Benjamin J. Jacobs, an orthopaedic surgeon, answers your questions about carpal tunnel syndrome.

Q: What is the carpal tunnel?
A: It is an actual tunnel made from the bones in your wrist and a tough ligament. The carpal tunnel nerve (median nerve) and several tendons run through the carpal tunnel. The thumb, index finger, middle finger and half of the ring finger get their sensibility from the carpal tunnel nerve.

Q: What does carpal tunnel syndrome feel like?
A: It varies on the person. The most common feelings people tell me about carpal tunnel syndrome are numbness, tingling, pain, weakness, and clumsiness (frequently dropping things, difficulty with buttons or needle work). The numbness or tingling most often takes place in the thumb, index, middle, and ring fingers. Very commonly, people wake at night or in the morning and have to “shake out” the numbness from their hand.

Q: How does carpal tunnel syndrome happen?
A: Anything that increases pressure on the carpal tunnel nerve can cause carpal tunnel syndrome. Often, we don’t ever find out why someone develops carpal tunnel syndrome.  Sometimes we see carpal tunnel syndrome in the setting of certain medical conditions such as diabetes, thyroid problems, and pregnancy. Often it is not just one thing causing carpal tunnel syndrome, but a combination of factors.

Q: What activities make carpal tunnel syndrome feel worse?
A: Frequently, people will feel numbness or pain when sleeping, reading a book, typing, driving, or performing any other activity where the wrist is bent.  High impact or vibration on the palm of the hand may also make carpal tunnel syndrome worse.

Q: Why is my carpal tunnel syndrome worse when I sleep?
A: Most people sleep with their wrists bent. Even people who don’t think they sleep with their wrists bent often do so for a portion of the night. This is why night splints that keep the wrist straight can help relieve carpal tunnel syndrome symptoms.

Q: If I have carpal tunnel syndrome, why are all my fingers numb?
A: It may be that all of the fingers are numb because you have another condition as well as carpal tunnel syndrome, causing the fingers that don’t get their sensation from the carpal tunnel nerve to have problems also. In fact, it’s possible you don’t have carpal tunnel syndrome at all! More commonly, however, it is just part of the hand and fingers that get their sensation from the median nerve feeling numb, and you don’t realize that the other fingers are feeling normal because so much sensation comes from the median nerve.

Q: Did my work cause my carpal tunnel syndrome?
A: This is a hard question. There are very few jobs that we know of that “cause” carpal tunnel syndrome. Use of vibratory tools, especially in cold weather, or jobs that require prolonged wrist bending might cause carpal tunnel syndrome.  Carpal tunnel syndrome can have multiple causes in anyone, and work may be one of the contributing factors.

Q: How do you treat carpal tunnel syndrome?
A: We have several options for treating carpal tunnel syndrome. Night wrist splints, anti-inflammatory medications, stretching, hand therapy, injections, and surgery are options for treatment of carpal tunnel syndrome. If you do have carpal tunnel syndrome, you and your hand specialist will decide together which option or options are right for you.

Learn more about Carpal Tunnel Syndrome at www.handcare.org.

Dr. Jacobs is an orthopaedic surgeon at Rebound Orthopedics and Neurosurgery in Vancouver, Washington, and a member of the American Society for Surgery of the Hand. He sub-specializes in hand and upper extremity surgery and treats disorders involving bones, tendons, nerves, and blood vessels of the entire upper extremity in addition to general orthopedics. He is trained in fracture management, reconstruction, microvascular, and nerve surgery of the hand, arm, elbow, and shoulder.