Carpal Tunnel Syndrome: What Causes It, How It’s Treated, and What to Try When Standard Therapies Don’t Help

Carpal tunnel syndrome is one of the most common nerve disorders of our time. This syndrome is estimated to plague between four and ten million Americans, and it is more likely to affect middle-aged and older individuals. If you or a loved one suffer from carpal tunnel syndrome, you know it can cause significant pain and even prevent you from being able to work or participate in sports.

Read on to learn the basics about carpal tunnel syndrome and how it’s commonly treated. While some standard treatments work to reverse this condition, not everyone obtains relief. Fortunately, there is an innovative area of medicine that you may want to explore if regular treatments don’t stop your symptoms of carpal tunnel syndrome.

The carpal tunnel is a passageway in the wrist through which nerves travel. This tunnel is quite rigid and unable to expand. When one of those nerves is compressed — usually the median nerve — it can cause symptoms known as carpal tunnel syndrome. In medical jargon, this is known as entrapment neuropathy.

What are the symptoms of carpal tunnel syndrome?

• Numbness and tingling in the hand or forearm (lower part of the arm) that can feel like an electric shock
• Pain in the hand or forearm
• Loss of sensation
• Weakness and inability to perform certain movements or tasks, like holding things in your hand, writing, typing, etc.
• Involuntarily dropping things from your hand

Carpal tunnel syndrome typically gets worse over time when it’s not treated. If left untreated long enough, your symptoms can become irreversible, meaning they’re permanent.

There are multiple possible causes of carpal tunnel syndrome. Often, this condition is caused by more than one factor, and several issues acting together produce pain and disability. Common causes include:

• Wrist fracture
• Rheumatoid arthritis and other inflammatory conditions
• Anatomical defects, including being born with a narrow carpal tunnel
• Nerve-damaging diseases like diabetes
• Obesity
• Fluid retention (including during pregnancy)
• Workplace factors, including certain repetitive motions or prolonged flexed position of the wrist
• Sleeping, reading, and other activities with the wrist flexed
• Using vibrating tools for long periods
• Sports that involve heavy use of the wrist, such as racket sports, bodybuilding, rowing, archery, rock climbing, etc.

Women are at higher risk of developing carpal tunnel syndrome because they naturally have smaller carpal tunnels compared to men.

If you seek professional care for your carpal tunnel syndrome, you may undergo several different methods of diagnosis:

• Physical examination to provoke or replicate symptoms and look for atrophy in the muscles at the base of the thumb
• Electrophysiological tests of the median and other nerves, like nerve conduction studies (NCS) and electromyogram (EMG)
• Ultrasound testing (AKA doppler)
• X-rays (which can also rule out other causes of your pain)
• MRI (magnetic resonance imaging) for looking at soft tissue

Your physician will likely recommend one or more standard treatments if you have a positive diagnosis for carpal tunnel syndrome. These include:

• Changing activity:eliminating the thing that’s causing your pain (not always practical if it’s work-related or welcome if it’s a leisure activity)
• Improving workplace ergonomics:repositioning your chair, desk, computer keyboard, mouse, steering wheel, factory equipment, etc.
• Bracing or splinting:designed to keep the wrist in a neutral position, including during sleep
• Nerve gliding exercises (AKA “neural flossing”):help the nerves move with less friction in the carpal tunnel
• Non-steroidal anti-inflammatory drugs (NSAIDs):over-the-counter naproxen or ibuprofen to reduce swelling
• Steroid injections: injecting cortisone to reduce pain and swelling
• Surgery: a carpal tunnel release to relieve pressure on the median nerve

The last three treatment methods on the list above aren’t without downsides, however. Over-the-counter pain medications can cause high blood pressure, stomach bleeding, worsening of acid reflux, and increased risk of cardiovascular events like heart attack and stroke.

Steroid injections can only be used temporarily; they’re not supposed to be a long-term treatment. And surgery is, of course, the highest risk of all, between the possibility of reactions to anesthesia and postoperative blood clots and infection. Plus, surgery can be expensive and require extensive recovery time. There’s no guarantee it will make your carpal tunnel syndrome better. In fact, in some cases, there can be worsening nerve pain.