The pain in your hand and wrist could be carpal tunnel syndrome

There are several conditions that can cause pain in the hands and wrists, and one of the most common is carpal tunnel syndrome (CTS), according to Peter Laub, MD, a plastic surgeon with Cape Cod Healthcare Plastic Surgery in Mashpee.

“The classic symptoms are numbness and tingling in the thumb, middle and index fingers, and half of the ring finger,” he said. “Often, people wake up during the night shaking out their hands to ease the numbness and tingling because they tend to flex their wrist down causing pressure in the carpal tunnel space.”

What Causes Carpal Tunnel Syndrome?

For the most part, it’s too much pressure in the carpal tunnel, a narrow passageway in the wrist area on the palm side of your hand, said Dr. Laub. The carpal tunnel contains nine tendons and the median nerve, (which originates from a group of root nerves in the neck) and provides sensation to that part of the hand. The carpal bones comprise the floor and sides with the transverse carpal ligament making up the roof. There isn’t a lot of room for swelling or other problems.

The space gets smaller when your wrist is in different positions, especially when it is bent down, forward or backwards. These movements increase pressure in that space.

The tendons are not usually affected if they get a little extra pressure from swelling or changes in the anatomy, but the nerves are pretty sensitive, Dr. Laub said. When a nerve is upset or under pressure, it tends to send off signals, like numbness and tingling, and sometimes pain.

“Most cases of carpal tunnel syndrome are idiopathic, meaning there is no definite cause other than a little bad luck with anatomy or some activities that can cause pressure on the nerve,” he said.

Other causes include the following, according to Dr. Laub:

• Pregnancy: Swelling throughout the body as a result of pregnancy can cause carpal tunnel syndrome temporarily. A cortisone injection can provide temporary relief until after the baby is born and the swelling subsides.
• Rheumatoid arthritis and gout, which are inflammatory diseases that can cause swelling in joints.
• Hypothyroidism: Long-term hypothyroidism can cause tissue swelling in the wrists and pressure on the median nerve in the carpal tunnel.

Carpal tunnel syndrome can also be a symptom of disease. The Journal of the American Medical Association published a study in 2023 that showed CTS was associated with an increased incidence of new onset heart failure (HF) and transthyretin (ATTR) cardiac amyloidosis.

“In rare circumstances, carpal tunnel syndrome is the first sign of amyloidosis, abnormal deposits of protein in your body that can cause swelling and pressure in the carpal tunnel,” said Dr. Laub. “To diagnose amyloidosis, I take a tissue biopsy from the carpal tunnel during release. An early diagnosis of amyloidosis can be helpful because you can stave off some of the associated heart problems with new medications.”

Diagnostic Testing and Treatment

Carpal tunnel syndrome is a highly treatable disease, with a good success rate, according to Dr. Laub.

“Carpal tunnel syndrome is typically a clinical diagnosis with an examination in my office including pressing on the carpal tunnel to see if it elicits numbness,” he said. “I also recommend an EMG/NCS (electromyography/nerve conduction study) test for most of my patients because carpal tunnel can mimic other problems like a pinched nerve in the neck (cervical radiculopathy).

“Emerging testing that can be a good diagnostic tool in an in-office exam is the ultrasound,” said Dr. Laub. “It is a newer technique that I am learning and could be an offering as a possibility for some patients.”

Treatment begins with conservative measures like splinting the wrists at night and reduced activity, he said. The next level up is to create more space in the tight area of the carpal tunnel, which can be done in two general ways:

• Treatment option one - In the office or a surgical center using a local anesthetic with numbing medication. Dr. Laub makes an incision in the palm of your hand which is about 2 cm (.78 inches) in length and cuts the transverse carpal ligament to release it, which provides more space in the tunnel. There is no fasting with this procedure and patients can drive themselves to and from the procedure.
• Treatment option two – The same as treatment one, except the incision is made a little closer to the wrist crease, using a small camera, and is done under anesthesia. Patients don’t experience as much sensitivity during recovery as patients with a palm incision, but the tradeoff is the patient needs to stay perfectly still during the procedure, which is the reason for anesthesia. Dr. Laub does this procedure most commonly on patients that use their hands heavily at work which includes landscapers, chefs and police officers.

Most patients are able to get back to work or use their hand for regular activities at 2-4 weeks. Complete recovery for both procedures is about six months for the nerve to recover along its length and re-heal itself. The incisions are usually healed within four weeks.