Carpal Tunnel Syndrome Treatment
Dr. Pamela Mehta, MD
Hand Surgeon in San Jose
Dr. Pamela Mehta is an experienced hand & wrist surgeon renowned for her expertise in sports injuries and joint arthritis. She is the founder of Resilience Orthopedics.
With an impressive career and training under leading innovators, she has served as Chief of Orthopedics and National Orthopedic Director for a major orthopedic hospitalist group and advises several publicly traded companies.
Table of Contents
What is Carpal Tunnel Syndrome?
Nerve compression leads to pain and numbness in your hand. Without early medical intervention, you may end up requiring wrist surgery.
The cause of carpal tunnel syndrome is pressure on the median nerve as it passes through your wrist. At first, you may notice a minor tingling in your fingers, but as time goes on the compression gradually worsens. Classic symptoms of carpal tunnel syndrome include:
- Numbness or tingling in your thumb and first two fingers
- Sudden jolts felt in the thumb, index and middle fingers
- Weakness in your hand that might lead to you feeling clumsy and dropping objects
Carpal tunnel syndrome can become debilitating over time. It can restrict you from performing simple tasks like writing, cooking, or typing due to pain and weakness.
This condition can also lead to a range of other problems, such as trigger finger. Sometimes you will require surgery for carpal tunnel syndrome.
Radiating Pain From Carpal Tunnel Syndrome
Radiating pain is a type of pain that starts in one part of your body and spreads to another. It often follows a nerve pathway, meaning the pain travels along the nerves from the original site to other areas of the body.
For example, in shoulder impingement, the problem occurs in a nerve in the shoulder. However, this pain can travel to other areas that this nerve travels to, such as the elbow or the neck.
This type of pain is commonly associated with nerve compression, irritation, or damage. When a specific part of your body is damaged, the surrounding nerves send pain signals to the spinal cord. Since all nerves in your body are connected, pain signals can spread.
The best way to differentiate radiating pain due to carpal tunnel from other conditions is to pay attention to your symptoms.
Keep in mind the following:
- Pain caused by carpal tunnel feels like shooting pain or an electric shock
- Carpal tunnel also causes pain and numbness in your fingers (thumb, index finger, and middle finger)
- Carpal tunnel can cause weakness in the affected hand
If you’re experiencing these symptoms alongside pain in the same arm, it might be radiating from carpal tunnel syndrome.
However, you should always check in with a hand doctor to confirm the diagnosis. They will explain why you are experiencing shoulder or elbow pain, and can work with you on a treatment plan.
Can Carpal Tunnel Syndrome Cause Elbow, Shoulder, or Neck Pain?
Besides causing symptoms such as hand pain and tingling, numbness, or weakness in your wrist and hand, carpal tunnel syndrome can radiate and cause pain in the shoulder, elbow, or neck.
Pain that you experience due to a compressed median nerve at your wrist can travel up to your elbow and reach your shoulder and neck. As a result, it becomes more difficult for you to perform daily activities.
Why does this happen?
Carpal tunnel can radiate because the median nerve is quite long. It runs along the inner part of the upper arm and passes through the elbow region, then travels through the carpal tunnel to your wrist.
This means that, if the median nerve is compressed at any point, it can radiate to other parts of the arm, shoulder, or neck that the median nerve supplies.
Differentiating pain in the shoulder, elbow, and neck from other conditions involves assessing the symptoms you’re experiencing.
If carpal tunnel is the culprit, you should also notice symptoms such as numbness in your hand and fingers. You may also notice red flags such as:
- Sudden onset of pain
- Progressive weakness of the affected hand
- Symptoms worsen at night
Book a Consultation with Dr. Pamela Mehta, MD
The Best Orthopedic Surgeon in San Jose
Dr. Mehta is a board-certified orthopedic surgeon who can help you recover from your joint condition.
We can help if you:
- Are Suffering From Pain and Mobility Issues
- Need Orthopedic Assessment and Advice
- Want Treatment From a Top Orthopedic Doctor
Carpal Tunnel vs Cubital Tunnel Syndrome
Carpel Tunnel Syndrome
Carpal tunnel syndrome is a condition indicated by pressure onto the median nerve in the carpal tunnel. The carpal tunnel is a narrow passage on the inner side of your hand surrounded by bones and ligaments. Compression of the median nerve causes symptoms such as:
- Numbness
- Tingling
- Weakness
The symptoms primarily affect your thumb and fingers (thumb, index finger, and middle finger).
Cubital Tunnel Syndrome
Cubital tunnel syndrome, on the other hand, is defined as a neuropathy of the ulnar nerve. The ulnar nerve is a nerve that controls feeling and movement in your hand, ring finger, and pinky finger.
Cubital tunnel syndrome is characterized by pressure or stretching of the ulnar nerve. This causes symptoms such as numbness and shooting pain in the following areas:
- Inner part of your forearm
- Fourth (ring) finger
- Pinky finger
The Difference
The main difference between carpal tunnel vs. cubital tunnel is in the affected nerves and their location:
- Carpal tunnel involves compression of the median nerve at your wrist.
- Cubital tunnel syndrome affects the ulnar nerve location at your elbow.
You can tell these conditions apart based on where you feel the pain.
For instance, carpal tunnel syndrome causes pain, numbness, or tingling in your:
- Thumb
- Index finger
- Long (middle) finger
Whereas cubital tunnel syndrome affects the ring finger and pinky finger.
Carpal tunnel syndrome is more common than cubital tunnel. Estimates show that between 1% and 5% of the general population has carpal tunnel syndrome. Cubital tunnel syndrome is 13 times less common compared to carpal tunnel syndrome. Numbers show that cubital syndrome affects approximately 1.8% of the U.S. population
Diagnosis
The diagnosis of carpal tunnel syndrome requires expert evaluation by a specialist. There are several other conditions which mimic carpal tunnel syndrome, such as:
How to Test for Carpal Tunnel at Home
Tinel’s test is the best way to check for symptoms of carpal tunnel syndrome at home – though you should always follow this up with a visit to your hand surgeon. This test may detect irritated nerves. In order to perform this test, you need to:
- Place the affected hand on a flat surface with the palm facing upward
- Tap the middle area of the affected wrist with the opposite hand
If the tapping action causes numbness or tingling, you may have carpal tunnel syndrome.
However, it’s always better to see the doctor rather than perform carpal tunnel test at home. The doctor can diagnose the cause of your symptoms and recommend the most suitable treatment.
Investigations
It’s important that you get the correct diagnostic tests. Appropriate tests can include:
- A thorough physical exam to test the nerves in the hand and the motion at the wrist
- An X-ray to help rule out other conditions
- Electrophysiological tests including nerve conduction studies and electromyogram
X-ray
X-ray of the affected wrist doesn’t diagnose carpal tunnel syndrome. The doctor may recommend this test to rule out other potential causes of pain in this area.
For instance, fractures or arthritis can cause symptoms such as pain too, and these would be diagnosed by x-ray.
Ultrasound
Ultrasound is a type of imaging test that relies on sound waves to create pictures of tissues, organs, and other structures in your body. Carpal tunnel ultrasound shows an image of your nerves and tendons, thus revealing whether the median nerve is compressed.
Ultrasound measurement of the median nerve area is beneficial for diagnosis of patients with carpal tunnel syndrome. It may serve as the initial diagnostic test, according to research. In fact, ultrasound may eliminate the need for electrophysiological testing.
The ultrasound itself is simple and painless. During the test, you will need to lie on a scanning bed or sit down with your hand on a bed or table.
The sonographer (ultrasound technician) applies the gel over the affected wrist. Then, they take images and will write a report to your hand surgeon.
Nerve Conduction Studies
Nerve conduction study is a type of electromyography. Electromyography is a test that measures small electrical signals from your muscles.
For the purpose of nerve conduction study, electrodes are taped on your skin. Then, a small painless shock passes through the median nerve.
The main goal is to see whether electrical impulses slow down in the carpal tunnel of the affected hand. The speed at which nerves function speaks a lot about potential damage, and so we can make a diagnosis of Carpal Tunnel Syndrome or rule it out.
Treatment
After getting a diagnosis from a specialist, there are several ways you can improve your symptoms. At Resilience Orthopedics we will help you explore all your non-surgical options. These can include:
- Carpal tunnel exercises, under supervision of an orthopedic surgeon or physical therapist
- A brace or splint, to help reduce the pressure on your median nerve
- Cortisone injections to reduce inflammation
If your symptoms are severe or not improving, you may require surgery for carpal tunnel syndrome. This is called carpal tunnel release and reduces the pressure on your median nerve at the wrist.
Carpal Tunnel Injection
Carpal tunnel injection is usually recommended when:
- Conservative therapies aren’t effective
- Before surgery to confirm the diagnosis when diagnostic tests are inconclusive
Injection Under Ultrasound
Carpal tunnel injection ultrasound serves to guide the placement of the needle into the carpal tunnel.
It makes it easier for doctor to inject a small dosage of medications such as corticosteroids. The purpose of a corticosteroid injection is to lower inflammation or swelling that affects the median nerve.
Ultrasound is necessary here to guide the placement of the needle.
Ready to Recover?
Take the first step in getting back to your normal self, and book an appointment with Dr. Mehta today.
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Carpal Tunnel Release Surgery
Carpal tunnel release is a surgical procedure to reduce pain, tingling, and numbness, and restore muscle strength. The main objective of the surgery is to alleviate pressure by cutting the ligament that is pressing your median nerve.
There are different types of surgical procedures for carpal tunnel syndrome.
Ultrasound Guided Carpal Tunnel Release
Ultrasound-guided carpal tunnel release is a minimally invasive hand surgery. The surgeon uses ultrasound to see anatomy in the hand and wrist.
During the procedure, the surgeon makes a tiny incision to cut the ligament with a cutting instrument. The main purpose of ultrasound is to help surgeons monitor carpal tunnel structures.
Since this type of surgery is non-invasive, recovery time is short and you may return to work and other activities within a couple of days. The procedure allows for rapid recovery and immediate motion of your hand.
Can I Get Carpal Tunnel Syndrome Twice?
While this condition is treatable, what happens if the symptoms come back?
Recurrence of carpal tunnel isn’t uncommon, which is why it’s important to see the doctor if symptoms appear. Sometimes a treatment, such as steroid injection, might wear off, or a surgical procedure might not be fully effective.
Other times, you might start to get symptoms of carpal tunnel in the previously unaffected hand. Carpal Tunnel Syndrome can occur in both hands, and might come on after you’ve already have treatment for your first episode.
To minimize the recurrence of the carpal tunnel you should:
- Adhere to the doctor’s instructions
- Modify your lifestyle, such as your work or hobbies, to avoid repetitive movements in your wrist
- Give your hands enough breaks from repetitive motions.
What Hand & Wrist Services Do We Offer?
Hand & Wrist Pain Assessment
We use our hands every day of our lives for some of the most important of life's activities. Hand and wrist pain can be debilitating, meaning you struggle to drive, write, and play sports.
Hand & Wrist Surgery
If your hand condition is severe, or nothing you have tried has helped, Dr. Mehta can advise you on the options for surgery. She is a hand surgeon and can offer expert opinion and care.
Treatment of Hand & Wrist Conditions
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome causes pain and numbness in your hand, and sometimes requires surgery.
De Quervain's Tenosynovitis
De Quervain's Tenosynovitis causes swelling and pain at the base of your thumb.
Wrist Bursitis
Wrist bursitis can cause pain and stiffness if your wrist. Treatment is often non-surgical.
Trigger Finger
Dr. Mehta is experienced in trigger finger injection and release surgeries.
Dr. Mehta offers diagnosis and treatment of all hand & wrist conditions and can offer her specialist opinion as an expert hand doctor.
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