Feeling pins and needles. Tingling. Swelling. Numbness.
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No matter which of these symptoms you suffer from, they’re often an early warning sign of carpal tunnel syndrome — especially if your symptoms are in the thumb, pointer and middle finger, says rheumatologist Scott Burg, DO.
“Not all hand pain is carpal tunnel syndrome, of course,” says Dr. Burg. “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. Over time, the muscles in your hand will weaken, leading to difficulty with grip.
If this sounds like you, it’s time to consult your doctor. It’s worth ruling out other hand or wrist issues to get the proper treatment.
Step 1: Get the right diagnosis
Reaching out to your doctor is the best first step you can take to find relief. 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 and 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 will also ask about your overall health 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,” says Dr. Burg. “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.”
Step 2: Try wearing splints
Have you ever noticed that the pain starts when you’re trying to sleep? That’s because symptoms usually begin at night.
“It’s tough to control your wrists while you sleep,” says Dr. Burg. “That’s why many patients have nighttime symptoms. Wearing a wrist splint can make a big difference because it keeps your wrists straight, avoiding pressure on your nerve.”
If you can wear them for your job, wearing splints during the day may help, too. 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 they can 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,” he says. “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.”
The National Institute of Neurological Disorders and Stroke recommends talking to your doctor about prescription medicine or alternative therapy like acupuncture of chiropractic care.
Step 3: Seek medical therapy for tougher cases
If wearing splints and changing your movement doesn’t help, your doctor may recommend cortisone injections.
“For many, injections provide relief for months or even years,” says Dr. Burg. “But these shots can weaken tissue over time, so we don’t use them for extended time periods. We typically won’t recommend more than two in a year.”
In more severe cases, surgery may be your best option. The good news is carpal tunnel release surgery is common, has a high rate of success and is usually done under local anesthesia. Most people can return to regular activities within six weeks.
If you do need surgery, your doctor may recommend that you wear a splint for a while afterward. Working with an OT afterward can help with recovery, along with altering your habits at work to help you take the strain off for the future.
