Do you often wake up in the night with a feeling of “pins and needles” in your hands, like they’ve fallen asleep? Does it get better if you shake them?
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That’s often an early warning sign of carpal tunnel syndrome — especially if your symptoms are in the thumb, pointer and middle finger.
Not all hand pain is carpal tunnel syndrome, of course. It’s a very specific nerve issue with telltale signs. When the carpal tunnel — a passageway in your wrist — becomes too crowded because of inflammation or compression, you get pressure on your median nerve.
On top of those nighttime sensations, you may also have tingling during the day and numbness in your fingertips. And over time, the muscles in your hand will weaken, leading to difficulty with grip.
If this sounds familiar, see a doctor. It’s worth ruling out other hand or wrist issues to get the proper treatment.
“It’s tough to control your wrists while you sleep. That’s why many patients have nighttime symptoms. Wearing a wrist splint can make a big difference.”
Scott Burg, DO
Department of Rheumatologic and Immunologic Disease
Get the right diagnosis
Expect a few possible tests during a doctor’s visit:
- Tinel’s sign: Your doctor taps on the underside of your wrist to test how your nerves respond. Many patients feel what they describe as an electric sensation.
- Visual and physical exam: In the worst cases, your doctor may be able to see the muscle loss at the base of your thumb.
- Phalen’s sign: You’ll put your hands in a position similar to praying, then let them fall forward naturally. This position often triggers symptoms.
- EMG and nerve conduction: Your doctor may recommend this test, which is a more involved way to assess nerve function.
Your doctor also will ask about your overall health. That’s because diabetes, rheumatoid arthritis, an overactive thyroid and other conditions often go hand-in-hand with carpal tunnel. Pregnancy and heredity play a part, too.
On the whole, treatment will target the symptoms of carpal tunnel syndrome. But it’s important to know how it fits into the big picture. For example, if you have rheumatoid arthritis, treating it may reduce your carpal tunnel symptoms, too.
Your first option: Brace yourself
For mild cases, we often start treatment where symptoms begin — at night.
It’s tough to control your wrists while you sleep. That’s why many patients have nighttime symptoms. Wearing a wrist splint can make a big difference. A wrist splint keeps your wrists straight, avoiding pressure on your nerve.
If it’s appropriate for your job, wearing splints during the day may help, as well. Although carpal tunnel can happen on any job, repetitive activities — like typing on a computer keyboard or working on an assembly line — can take a toll, especially if your form is improper.
That’s where an occupational therapist (OT) can help. An OT can not only improve your workstation to avoid stress and strain, but also help you change the way you move your hands and wrists.
You can try anti-inflammatories for pain relief, too, but the relief they provide may be minimal. The same is true of ice. Icing other types of hand or wrist conditions provides relief, but the issues with carpal tunnel are often deep enough that ice won’t offer much help.
Seek medical therapy for tougher cases
If wearing splints and changing your movement does not help, your doctor may recommend cortisone injections.
For many patients, injections provide relief for months or even years. But these shots can weaken tissue over time, so we don’t use them for extended time periods. And we typically won’t recommend more than two in a year, for instance.
In more severe cases, surgery may be your best option. The good news is carpal tunnel “release” surgery is common and has a high rate of success. Most people can return to regular activities within six weeks.
If you do need surgery, you also may need to wear a splint for a while afterward. And working with an OT afterward can help with recovery — and with altering your habits at work to help you take the strain off for the future.