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When you stop and think, we have been given two remarkable instruments to help us in life: our hands.

Our hands distinguish us from the rest of the animal world. They are capable of an amazing variety of functions. Our hands can be used to grip like a vice, explore the world, bring food to our mouths or play the violin.

As our hands are used and overused throughout life, it is not surprising that they can become a source of pain.

Symptoms

Carpal tunnel syndrome is only one of many causes of hand pain. The symptoms can be minor or severe, and sometimes disabling.

Carpal tunnel syndrome occurs more frequently in women and sometimes starts during pregnancy, but also can occur in men. Although carpal tunnel syndrome may be aggravated by work, it frequently occurs in people who are not working with their hands. It is sometimes associated with medical illness, but can occur for no apparent reason.

Causes

Carpal tunnel syndrome is related to pressure on the median nerve which is one of three important nerves that supply sensation to the hand.

As the nerve travels from the neck to the hand, it passes through a tunnel in the wrist: the carpal tunnel.

Like all nerves, the median nerve is a delicate structure. In the tunnel, the median nerve is accompanied by nine tendons, which are tough and fibrous.

The carpal tunnel has a normal resting pressure. In most of us the pressure is low. In some of us, the pressure is higher.

Any activity that raises the pressure in the carpal tunnel affects the tendons and nerve. The tendons are durable and tolerate the pressure well. In contrast, the median nerve is delicate and is vulnerable to pressure changes. Even mild increases in pressure that are sustained over a prolonged period of time can result in symptoms of pain and numbness.

Factors that increase the pressure within the carpal canal, include bending at the wrist and repetitive wrist motion.

As the pressure within the carpal canal increases, the median nerve is compressed and symptoms of unpleasant tingling and numbness are experienced. In most cases the little finger is spared.

If you have pain, numbness, and tingling in the fingertips of your hand with manual activity and are awakened with these symptoms at night, you may have carpal tunnel syndrome—ask your doctor.

Treatment

Be sure to describe the location of your pain to your doctor. Also, mention the activities which aggravate and relieve your pain.

Your doctor will examine your hand and look for changes in muscle contour and sensibility.

Your doctor may order blood tests and an X-ray. Frequently electrical studies are needed.

Nerves are like wires; they conduct electricity. If a nerve is compressed the speed of electrical conduction is slowed. In carpal tunnel syndrome, the speed of conduction of the median nerve is decreased. This delay in conduction can be measured.

Although carpal tunnel syndrome can be painful, even disabling, there are many things which you and your doctor can do to relieve your pain.

  • Wrist splints can be used to decrease bending.
  • Hard splints can be used at night, and soft splints can be used during the daytime depending upon your needs.
  • Your doctor may prescribe medications. Sometimes steroid injections are indicated.

If you believe your problem is aggravated at your work, sometimes simple changes can make a difference. For people who sit at a desk or keyboard, the working surface should be adjusted so that the majority of work can be performed with the wrist in neutral position—not bent upwards or downwards. This can sometimes be accomplished by simple adjustment of the chair.

Many people are required to perform repetitive activities at work. With careful planning some activities can be alternated.

If conservative measures fail, or if your condition is severe and affects the muscles in the hand, your doctor may recommend surgery.

Fortunately, the roof of the carpal tunnel is covered by a fibrous ligament, which can be released by your surgeon.

Remember, the problem of carpal tunnel syndrome is related to pressure on the median nerve. If the roof of the carpal tunnel is opened, even slightly, studies indicate that the volume of the carpal tunnel increases by 26%—enough to relieve most of the pressure on the nerve.

Your Recovery

If surgery is performed, it is unnecessary to stay in the hospital. The type of anesthetic can be chosen by you and your doctor.

Although you may have carpal tunnel syndrome in both hands, usually surgery is staged, so that it is performed on one hand followed later on the other hand.

After surgery, your hand will be covered by a bandage. It is important to keep this dry, and to elevate the hand so that it is above the heart as much as possible. Your doctor will prescribe medication for pain, but if the pain becomes severe, call your doctor.

In a few days, your doctor will remove the dressing and apply a smaller dressing. In 2 to 3 weeks, he will remove the stitches.

  • It is important to keep the hand dry until the sutures are removed by your doctor.
  • As in all operations, problems can occur. Call your doctor for excessive pain, swelling or numbness.

You can return to normal activity as recommended by your doctor. At work, try to avoid continuous repetitive movements by alternating activities as much as possible.

Be kind to your hands

Your hands are remarkable instruments which can serve you well throughout life, but it is important that you take good care of them.

  • Do not use your hands as a hammer. Avoid trauma, as much as possible and use a real hammer.
  • Wear protective gloves when doing hard work or when in cold weather.

If you have surgery, finger motion can reduce swelling. Move your fingers, even while wearing your splint. Do not drive until you are able to make a firm fist.

We are lucky to have our hands. They have been given to us to use throughout life. If we are kind to our hands, they will be kind to us.