Carpal Tunnel Syndrome: Symptoms, Treatment, and Recovery

Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy, impacting between 3% and 6% of the U.S. adult population and making up an estimated 90% of all neuropathies. When this painful and debilitating condition becomes acute, it requires surgery to alleviate the pain, prevent permanent damage, and improve mobility. If you have a carpal tunnel syndrome diagnosis, you may have concerns about the procedure and recovery time, including how much time off work you may need and whether workers’ compensation in New York covers CTS.

Understanding Carpal Tunnel Syndrome

In your wrist, you have a group of bones called carpal bones. The transverse carpal ligament binds these bones together tightly, leaving just a 1-inch opening. Flexor tendons and the median nerve pass through the carpal tunnel. The median nerve begins in the neck as a nerve bundle that combines into a single nerve in the arm before traveling down the arm to the fingers.

The flexor tendons permit you to move your fingers and thumb, while the median nerve controls muscle movements in the hand, wrist and forearm. This nerve also conveys sensory information from the hand and lower arm to the brain. The synovium encases the flexor tendons, lubricating them to improve movement. If the synovium swells, it compresses the median nerve, causing inflammation and leading to carpal tunnel. Often, people can take measures to alleviate symptoms in the early stages, but if the condition persists, they may need carpal tunnel release surgery.

Carpal Tunnel Symptoms

This condition arises slowly and progresses over time unless the individual takes steps to reverse symptoms early. However, people often find it challenging to stop the types of movement that cause them to develop carpal tunnel syndrome in the first place. It’s important to diagnose carpal tunnel syndrome early to prevent symptoms from worsening. Symptoms may include:

• Feeling tingling, burning, pain, and numbness: Typically, you feel these uncomfortable sensations in your thumb and the three fingers your median nerve runs to.
• Feeling shocks: You may feel like you get little shocks that radiate out to your fingers – especially the thumb.
• Radiating tingling, burning, and pain: As your condition progresses, you may notice that these symptoms are not just in your fingers but that they also travel up your arm.
• Weakening in the hand: Severe carpal tunnel leads to hand weakness that makes it difficult to grasp objects or perform fine motor functions. It is at this point that many consider carpal tunnel syndrome treatment or surgery.
• Losing your grip: At the acute stage of carpal tunnel syndrome, people often drop items they hold in the affected hand. This may occur from a lack of feeling, muscle weakness, or loss of proprioception (spatial awareness).

When people first experience indications, they often don’t persist. They may arise during specific activities and then go away. As the condition progresses, the symptoms worsen and last longer. People also frequently experience an increase in symptoms at night because they sleep with their wrists in a flexed position, which puts additional pressure on the median nerve.

Carpal Tunnel Syndrome Contributing Factors

Carpal tunnel has many potential causes and risk factors, and it is often hard to determine a single factor that led to the condition. Even though you may often hear people referring to it as a repetitive use condition, anything that leads to median nerve compression or swelling may contribute to carpal tunnel development.

Age Factors

Older people are more likely to develop severe carpal tunnel. There are two age group peaks for developing carpal tunnel. Middle-aged adults aged 50-54 and elderly adults aged 75-84 are more likely to have carpal tunnel than other age groups. Elderly adults have more severe cases and demonstrate higher rates of thenar muscle (the muscles that move the thumb) atrophy. Carpal tunnel release surgery is a viable option for people with CTS in any age group.

Sex

Anyone can develop CTS, but women have a higher chance of getting it than men, especially between the ages of 45 and 54. Their risk is three times greater, but scientists don’t know exactly why. One potential reason is the hormonal changes women undergo during pregnancy and menopause. Another possible factor that increases the risk for women is that their wrists are usually structurally smaller than men’s wrists, creating a smaller carpal tunnels for the median nerve and flexor tendons to pass through.

Your genes play a significant role in your body’s anatomical structure. If your family has a more petite skeletal frame, making your wrist smaller, heredity may be a contributing factor to your carpal tunnel. In addition to size, you may have other morphological features that reduce the amount of space in the carpal tunnel. Carpal tunnel surgery is often beneficial for those whose genetics contribute to their carpal tunnel syndrome.

Anatomy

Genetic factors aren’t the only causes for changes in people’s anatomical structure. A broken or dislocated wrist can alter the wrist bones, reducing the size or changing the shape of the carpal tunnel. A bone spur on a wrist bone may also lead to a crowded space that increases the risk of CST.

Obesity

People who have a high body mass index are more likely to develop CTS. One potential reason for the increased risk may be that significantly overweight people often have fluid buildup in their joints. As with many other contributing factors, this excess fluid increases the pressure on the median nerve.

Inflammatory Conditions

Inflammation causes swelling, so it may lead to carpal tunnel if the inflammation occurs in the wrist. Specific health conditions — such as rheumatoid arthritis — target the joints and cause inflammation in these areas. Other autoimmune diseases cause systemic inflammation that increases the potential for carpal tunnel. However, any type of inflammatory condition that causes swelling in the soft tissues surrounding the flexor tendons may contribute to or increase the risk of CTS.

Medical Conditions

In addition to diabetes and inflammatory conditions, other medical conditions may increase the risk of developing carpal tunnel. Examples of these diseases include diabetes, hypothyroidism, and end-stage renal failure. In some instances, carpal tunnel release surgery may ease the symptoms, especially if the underlying medical condition is chronic.

Body Fluid Retention

If your body retains excess fluid, the fluid may accumulate in the joints and increase the risk for CTS. In some instances, taking specific steps to reduce retention may improve your condition. Fluid retention is common for pregnant women and women going through menopause. Pregnancy-induced carpal tunnel syndrome often goes away on its own after giving birth.

Repetitive Motion Activities

While many attribute repetitive motion activities to work-related tasks, this category is broader than the activities people engage in at work. Any type of activity that people do on a regular basis that leads to repetition in hand and wrist movement or consistent gripping with the hand may contribute to CST and require carpal tunnel surgery.

Repetitive movement may cause flexor tendon irritation and swelling or thickening of the synovium, leading to increased pressure on the median nerve in the carpal tunnel. Examples of non-work-related repetitive motion activities include:

• Hobbies: Golf, tennis, playing the violin or piano, knitting, and cross-stitch are all examples of hobbies that may cause CTS.
• Phone use: Texting on your phone regularly increases the likelihood of developing CTS. If you talk on the phone a lot, it may also increase your risk of carpal tunnel. However, this is only true if you hold the phone up to your ear when you talk rather than using hands-free options.
• Writing: If you often write with a pen or pencil, gripping the writing utensil can aggravate the tendons in the wrist and lead to inflammation.
• Art: Painting, drawing, and sculpting all require the artist to grip a tool as well as engage in repetitive motions. This combination of behaviors places artists at risk of developing severe carpal tunnel syndrome.
• Computer use: Frequent computer use can lead to CTS even if it is not part of your job. There is significant controversy surrounding whether computer use contributes to carpal tunnel. Several studies indicate that excessive computer use does increase the risk of developing the condition — the more time spent at the computer, the higher likelihood of an individual having carpal tunnel syndrome. Hand and wrist ergonomics may play a role. Other research suggests that mouse use is a more significant concern than keyboard use. Finally, one study found no correlation between computer use and carpal tunnel.

Work-Related Activities

Your occupation may be a contributing factor in your CTS. As with any other factor, it is often difficult to pin down a direct cause. However, CTS does appear more prevalent in some jobs than in others. A national health interview survey found that of the 6.7% of respondents who had clinically diagnosed CST, clinicians in 67% of the cases attributed the condition to the patient’s work.

According to a Centers for Disease Control (CDC) report, the association between occupation and carpal tunnel is higher for those who:

• Work on assembly lines
• Manufacture textiles
• Prepare food
• Drive a vehicle
• Lift heavy items repeatedly
• Work on computers

Interestingly, one study demonstrated that carpal tunnel is more prevalent in occupations that do not require significant computer usage than those that do. When CST is work-related, workers’ compensation may cover carpal tunnel surgery. However, demonstrating that your job caused your carpal tunnel can be challenging. Additionally, in places like New York, workers’ compensation boards may have specific guidelines for you to follow before you can consider undergoing surgery if you want it covered under workers’ compensation. At Accident Help Zone, we provide resources for anyone who needs information about workers’ comp in New York.

Knowing Your Treatment Options

Carpal tunnel is painful and debilitating, and it’s important to address the issue before you sustain permanent damage. Your options, including carpal tunnel release surgery, depend in part on how severe your condition is, what you’ve tried so far and whether you plan to file a workers’ compensation claim. Diagnosing carpal tunnel syndrome is an important part of this process.

No Treatment

Your first option is always to do nothing. Unfortunately, carpal tunnel syndrome doesn’t typically go away if you don’t take any steps to reduce the inflammation. Instead, the condition worsens over time. Without treatment, you may end up with permanent nerve damage that surgery can’t resolve.

Non-Surgical Approaches

If your CST is in the early stages, your doctor may recommend non-surgical options, including:

• Wearing a splint or brace
• Nerve gliding exercises
• Steroids

However, your symptoms are likely to return without subsequent changes to your environment or activities.

Surgical Options

Surgeons perform an estimated 400,000 surgeries for carpal tunnel every year. If your injury is work-related, your state may require you to try all non-surgical options before the workers’ comp board approves a claim for surgery. A CST surgeon performs the surgery in one of two ways.

Both types are out-patient procedures, so you are in and out in a short time. They both also accomplish the same outcome: They open the carpal tunnel to alleviate the pressure on the median nerve.

Open Carpal Tunnel Release Surgery

Initially, open release surgery was the only option available. In this procedure, doctors anesthetize the hand and wrist before performing the surgery. They then make an incision on the wrist, running from the palm down to the bottom of the wrist. The incision exposes the transverse ligaments that cross over the median nerve and flexor tendons.

Next, surgeons carefully slice across the ligaments, separating them into two parts and, consequently, enlarging the carpal tunnel. Doing so alleviates the pressure on the median nerve. The ligaments may eventually grow back together, but there will still be extra room in the carpal tunnel.

Endoscopic Carpal Tunnel Surgery

The procedure for endoscopic release surgery is similar to open release surgery. The primary difference is in how the surgeon makes the incision and cuts the ligaments. When workers’ compensation doctors perform endoscopic surgery to treat carpal tunnel syndrome, they make a small incision and insert a tiny camera through the portal. They then manipulate the camera under the band of ligaments and use a knife attached to the camera to make the slice.

Surgery Risks

Though the risks of surgery for CST are few, you should still know what they are. For some people, anesthesia is a problem, but this happens most often when a person is under general anesthesia. Other potential risks include:

• Scarring that may be sensitive
• Infection
• Bleeding
• Damage to the median or other nerves in the wrist
• Damage to surrounding blood vessels

Contact your doctor if you develop a fever, experience itching, draining or swelling at the incision site, or have an increase in pain. These may be signs of an infection.

Determining Recovery Time

Many people who need surgery worry about how much time it takes to recover and when they can return to work. There is no straightforward answer to these questions. Every person’s situation is different, so recovery times vary and can range from a few days to several months for complete recovery from carpal tunnel release surgery.

After surgery, you will likely wear a splint or heavy bandage for up to two weeks. Your doctor will probably require you to come into the office for removal. Your doctor may also order physical therapy to speed up the healing process and improve wrist and hand functioning. You may also need to elevate your hand at different times during the day and overnight to reduce the swelling.

Restrictions After Surgery

Immediately after surgery, your doctor will likely talk to you about the activities that are safe for you to perform. Often, people can use their hands shortly after carpal tunnel surgery for activities such as driving, light lifting, and self-care. Your doctor may restrict other activities to ensure your wrist heals completely from carpal tunnel syndrome surgery. These restrictions may impact your work.

Returning to Work

Getting back to work is a significant factor for those deciding whether to pursue surgery for CTS. You may need to take a few days off work on the day off and immediately follow the procedure. However, many people can return to their jobs in some capacity before they fully recover. It often takes about a week before people can write for short periods of time, but it can take up to six weeks before you can perform tasks that require pinching, gripping, or pulling.

Before your surgery, you can discuss your options with your doctor and employer. Your physician may release you to go back to work before you fully recover, as long as you can perform light-duty activities. It may be helpful to determine potential alternatives for work tasks before you get the procedure done.

Finding the Information You Need About Carpal Tunnel Syndrome

At Accident Help Zone, our goal is to help people get the information and support they need when they have a workplace or auto accident. If you have carpal tunnel syndrome, you have the right to understand how the condition impacts your life and work. Doctors listed in our directory accept workers’ compensation, no-fault, and most insurance plans. Peruse our site, and if you have any questions, please feel free to get in touch or call (888) 412-8488 to schedule an appointment today!