Diagnosis of Carpal Tunnel Syndrome
The diagnosis of carpal tunnel syndrome is made in many patients based on their history of symptoms and a physical examination. It is important to know which fingers experience the numbness or tingling and which fingers do not. When performing the physical exam, your hand surgeon will perform sensation testing on the palm side and the back side of the fingers and hand. He or she may also perform sensory testing of the forearm and arm because finding numbness outside the median nerve area may suggest a different problem. The doctor may also perform some tests including the Phalen’s maneuver, the Tinel’s test, and a compression test. These tests are designed to increase pressure on the median nerve to cause your symptoms to appear. Electrodiagnostic studies (EMG) may also be used in the diagnosis. These provide evidence of nerve function or dysfunction. Also, they can help to find other causes of numbness which may have similar symptoms, such as diabetic neuropathy or cervical radiculopathy. Magnetic Resonance Imaging (MRI) and ultrasound studies are anatomic imaging tests that visualize the size of the median nerve and may also be used. Anatomic imaging tests are often helpful when other conditions are suspected like a ligament tear or tendinitis that may contribute to pain.
Therefore, it is possible that your doctor will diagnose you with a condition other than carpal tunnel syndrome. Other conditions that can cause numbness/tingling in the hand include compression conditions in the forearm, elbow, shoulder, or neck, fibromyalgia, myofascial pain syndrome and peripheral neuropathy.
Non-Surgical Treatment
The main goal of treatment is to reduce or remove the causes of increased nerve pressure. This should result in a decrease in symptoms. Some non-surgical treatment options may include:
- Oral anti-inflammatory medicine
- Steroid injection (cortisone shot)
- Wrist splint(s)
Oral medications and injections are more effective when symptoms are present for a short period of time, infrequent and mild. Wrist splinting, mainly at night, keeps the wrist out of a bent position. Wrist splints are most helpful with symptoms that are affected by the hand or wrist position. Splints are also more helpful when the symptoms are mild and when symptoms have been present for a shorter period of time. However, splints have been shown to improve, but not cure symptoms, even when carpal tunnel is severe. It can also be useful to limit activities that bring on numbness and tingling.
Surgical Treatment
Surgical release of the carpal tunnel ligament is one of the most effective treatments. It takes the extra pressure off the nerve immediately and reliably. There are several different surgical techniques to cut the transverse carpal ligament. By opening the ligament, there is more room for the tendons and the nerve to pass through the tunnel without pressure.
After carpal tunnel release surgery, your surgeon may recommend temporarily avoiding certain activities. Moving the fingers right away and frequently after a surgical procedure helps to limit stiffness, swelling, and adhesions. Adhesions are areas of scar tissue that can form and link the nerve to the tendons it rests on. If adhesions form, the moving tendon will pull on the nerve and may cause symptoms. Early, gentle finger and wrist motion can help avoid adhesions and encourage tendons and nerves to move separately.
The surgical scar and surrounding area may go through some mild changes in color, firmness and tenderness over the first several months. These changes are normal. Most scars won’t change much after four months. You may work with a hand therapist, who will give instructions on exercises and scar massage to get your hand function back to normal. Returning to work after carpal tunnel surgery is dependent upon each person’s symptoms, job demands and employer policies. In patients with less physically demanding jobs, they will be able to return to work in a few days, where other jobs may take weeks to safely return. Your surgeon and therapist will discuss the best recovery plan with you.
After surgery, most patients have very little pain at the incision site. Numerous scientific studies have shown surgical pain can be well-controlled with acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) (like Ibuprofen), ice, elevation, early gentle finger and wrist motion, and limiting activity to things that are comfortable. Very rarely a patient may require a few doses of a stronger opioid pain medication within the first 2-3 days. It is very important to limit this type of strong pain medication to decrease the chance of becoming dependent on the medicine, having a tolerance build up, or having withdrawal symptoms when trying to stop it. Multiple medical organizations and state licensing boards have established guidelines and policies on safe prescribing of pain medication. Please discuss any concerns with your surgeon prior to any surgery to make sure everyone is on the same page and expectations can be clearly set and understood.
Outcomes After Surgery
Better results will occur when carpal tunnel is recognized and treated earlier. This means seeking treatment when your symptoms are not severe, and they come and go. There will likely be complete return of feeling and muscle use after surgery. Relief may even be immediate.
However, if the symptoms are severe and constant when you seek treatment, the final result may be unknown. Your healing may be slow (six or more months). If there was permanent damage before surgery, you will likely still feel numbness. Unfortunately, there is no test to tell if the symptoms are reversible. If you lost use of your thumb muscle, that will likely persist, at least to some degree.
Visiting a hand surgeon as soon as your symptoms develop is key to receiving the best treatment and outcomes.
© 2021 American Society for Surgery of the Hand.
This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you.