Condition
Carpal Tunnel Syndrome
Carpal tunnel syndrome is compression of the median nerve where it passes through a narrow tunnel at the wrist.
- Seen at
- All three offices
- Typical wait
- Within the same week
- Treated with
- 4 procedures
In short
What carpal tunnel actually is.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is compression of the median nerve where it passes through a narrow tunnel at the wrist. That nerve supplies feeling to the thumb, index, middle and half the ring finger, which is why numbness follows that exact pattern and spares the little finger. Nerve conduction testing is what confirms it and grades how severe the compression has become.
Symptoms
How it shows up.
If several of these sound like your week, it is worth having the source looked at properly.
- Numbness or tingling in the thumb, index and middle fingers, with the little finger spared
- Waking at night needing to shake the hand out to get feeling back
- Hands going numb while driving, holding a phone or reading
- Dropping keys, coins or coffee cups without warning
- A weak pinch grip, trouble opening jars or turning a key
- An ache that travels up the forearm from the wrist
- Over time, flattening of the muscle at the base of the thumb
What causes it
- Repetitive gripping, vibration or sustained wrist flexion at work
- Fluid retention from pregnancy, thyroid disease or kidney disease
- Diabetes, which makes the median nerve more vulnerable to compression
- Rheumatoid arthritis or tenosynovitis swelling the tendons inside the tunnel
- A wrist fracture or dislocation that changes the shape of the tunnel
- A naturally narrow carpal tunnel, which often runs in families
When to act
Stop waiting when this happens.
Do not sit on these
Any one of the following is a reason to be seen rather than to wait it out.
- Numbness has stopped being occasional and is now present most of the day
- You are waking up more than a few nights a week to shake the hand out
- You have started dropping things or noticed weakness in your grip
- The muscle pad at the base of the thumb looks smaller than on the other hand, which signals nerve damage that does not fully recover
- A wrist brace has been tried for several weeks without meaningful change
Diagnosis
Finding the actual source.
A diagnosis is not a guess from an image. It comes from the exam, the history and, where nerves are involved, electrodiagnostic testing.
- Mapping the numbness finger by finger, since involvement of the little finger points away from the carpal tunnel and toward the elbow or the neck
- Provocative testing including Phalen and Tinel signs at the wrist, plus examination of thumb abduction strength
- Nerve conduction studies measuring how much the median nerve slows as it crosses the wrist, which is the definitive test and grades the compression as mild, moderate or severe
- EMG of the thumb muscles to determine whether the compression has already caused muscle fiber damage, which changes how urgently it should be treated
- Testing the ulnar nerve and the cervical nerve roots in the same session to rule out cubital tunnel and a pinched nerve in the neck, which frequently coexist with carpal tunnel
- Reviewing thyroid, A1C and inflammatory labs when the presentation suggests a systemic contributor
Nerve testing happens here, not elsewhere
EMG and nerve conduction studies are done in the office and read by Dr. Sheikh the same day, rather than sent out and waited on.
Treatment
How carpal tunnel is treated.
Ordered from the most common first step to the options reserved for pain that has not responded.
15–45 minNerve BlockA nerve block is an injection of local anesthetic, often with a steroid, placed next to a specific nerve or c…Read more →
45 minJoint InjectionsA joint injection places medication directly into a painful joint, either a corticosteroid to reduce inflamma…Read more →
Trigger Point InjectionA trigger point injection treats a knot in a muscle, a tight band that will not release and that often refers…Read more →
45–60 minPRP TherapyPRP therapy concentrates the platelets from a sample of your own blood and injects them into an injured tendo…Read more →Questions
Carpal Tunnel Syndrome, answered.
Do I need surgery for carpal tunnel?
Not necessarily. Mild and moderate cases often respond to night splinting, activity changes and a corticosteroid injection into the carpal tunnel. Surgery becomes the right answer when nerve conduction testing shows severe compression, when the thumb muscle is wasting, or when non-surgical treatment has failed.
Why does my hand wake me up at night?
Most people sleep with their wrists curled, which raises the pressure inside the carpal tunnel. Fluid also redistributes when you lie flat. The combination squeezes the median nerve, which is why shaking the hand out restores blood flow and relieves the numbness. Night symptoms are one of the most reliable signs of carpal tunnel.
Does a wrist brace actually work?
A neutral position brace worn at night helps a substantial number of people with mild to moderate compression, and it works best within the first year of symptoms. Give it four to six weeks. If the numbness is unchanged, or the nerve study shows severe slowing, a brace alone is not going to be enough.
How does an EMG confirm carpal tunnel?
Nerve conduction testing measures how fast the median nerve conducts across the wrist compared with segments above and below. A specific slowing right at the tunnel confirms the diagnosis and grades its severity. It also proves the problem is the wrist and not the neck, which imaging cannot settle.
Can neck problems be mistaken for carpal tunnel?
Frequently. A pinched C6 or C7 nerve root in the neck can produce numbness in the same fingers. Some people have both at once, which is called double crush syndrome. Testing the whole arm in one session is the only way to sort it out, and treating just one leaves the patient still symptomatic.
How long can I wait before getting it checked?
Intermittent night tingling can be observed for a few weeks with a brace. Constant numbness, weakness, or any thinning of the thumb muscle should be tested promptly. Severe compression left in place for a long time leaves permanent numbness even after successful release.
Is a cortisone injection in the wrist safe?
Done with proper technique and, where indicated, ultrasound guidance, it is a quick office procedure with a good safety record. Relief often lasts several months and can be long lasting in mild cases. Repeated injections into the same wrist are limited, and we would not keep injecting a wrist whose nerve study is worsening.
Get a real diagnosis for carpal tunnel.
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