Carpal Tunnel Syndrome: Specific Characteristics
Several commenters have written about carpal tunnel syndrome and pointed out that carpal tunnel syndrome is not the only condition to cause pain, numbness and weakness in the hand. It is important to consider other entities, which cause similar symptoms. Other possible causes include cervical radiculopathy (nerve damage near the cervical vertebrae), impingement of one or more of the cervical nerve roots which can cause pain and numbness radiating from the neck area and also ulnar nerve compression usually at the elbow (cubital tunnel syndrome). I think it is important again to review some aspects of carpal tunnel syndrome.
Carpal tunnel syndrome is a specific entity. It is compression of the median nerve at the wrist in a closed space called the carpal tunnel. Through that small space course the median nerve and all the flexor tendons. The median nerve supplies sensation to the thumb, index, middle and the thumb side of the fourth finger.
It is thought, but never proven that pressure builds up within that small space and causes compression of the median nerve – the symptoms are activity related and episodic.
Jobs such as packing and typing along with exercise are frequently associated with carpal tunnel syndrome. Individuals usually perform their activity then hours later commonly (at night) they awaken with the hands feeling as if they are asleep and they describe shaking their hands to try to bring back feeling into them.
The ulnar nerve supplies sensation to the fifth finger (pinky) and the pinky side of the fourth finger. The ulnar nerve frequently gets compressed at the elbow in the area known as the “funny bone”. There is a groove between the medial epicondyle of the humerus the bone in the upper arm and the olecranon process of the ulnar bone in the forearm and the nerve is compressed in that area. An EMG test is the definitive test to determine and distinguish between the entities affecting the different nerves and nerve roots whether it is the neck, elbow or wrist area. Compression may also inferred or diagnosed by an MRI.
Other entities noted by several bloggers include the repetitive strain injuries one of the buzz words of the 21st century. They include trigger finger, carpal tunnel syndrome and de Quervain disease (tenosynovitis of the first dorsal compartment on the thumb side of the wrist and tennis elbow).
Specifically, trigger finger is a swelling of the first portion of the flexor tendon sheath in the distal palm at the base of each finger. There is a covering that starts over the flexor tendon and extends almost to the end or distal portion of the finger. This first portion-swelling thickening occurs and prevents the smooth gliding of the flexor tendon hence triggering. Injection of steroid is the first option and then if that fails or it continues to recur after a second injection a surgical release or opening of the first portion of the flexor tendon is performed. I do not wish to minimize it, but it is a very small surgical procedure easily and quickly accomplished.
It is a matter of experience, clinical judgment and findings after careful examination of what should and should not be treated. Perhaps in an individual who has one or more problems they all should be treated, but it is a matter of good judgment about which one should be treated first or which is the main culprit or problem in each individual.
Related Topics:
Technorati Tags: carpal tunnel syndrome, elbow injury, neck injury
Carpal tunnel syndrome is a specific entity. It is compression of the median nerve at the wrist in a closed space called the carpal tunnel. Through that small space course the median nerve and all the flexor tendons. The median nerve supplies sensation to the thumb, index, middle and the thumb side of the fourth finger.It is thought, but never proven that pressure builds up within that small space and causes compression of the median nerve – the symptoms are activity related and episodic.
Jobs such as packing and typing along with exercise are frequently associated with carpal tunnel syndrome. Individuals usually perform their activity then hours later commonly (at night) they awaken with the hands feeling as if they are asleep and they describe shaking their hands to try to bring back feeling into them.
The ulnar nerve supplies sensation to the fifth finger (pinky) and the pinky side of the fourth finger. The ulnar nerve frequently gets compressed at the elbow in the area known as the “funny bone”. There is a groove between the medial epicondyle of the humerus the bone in the upper arm and the olecranon process of the ulnar bone in the forearm and the nerve is compressed in that area. An EMG test is the definitive test to determine and distinguish between the entities affecting the different nerves and nerve roots whether it is the neck, elbow or wrist area. Compression may also inferred or diagnosed by an MRI.
Other entities noted by several bloggers include the repetitive strain injuries one of the buzz words of the 21st century. They include trigger finger, carpal tunnel syndrome and de Quervain disease (tenosynovitis of the first dorsal compartment on the thumb side of the wrist and tennis elbow).
Specifically, trigger finger is a swelling of the first portion of the flexor tendon sheath in the distal palm at the base of each finger. There is a covering that starts over the flexor tendon and extends almost to the end or distal portion of the finger. This first portion-swelling thickening occurs and prevents the smooth gliding of the flexor tendon hence triggering. Injection of steroid is the first option and then if that fails or it continues to recur after a second injection a surgical release or opening of the first portion of the flexor tendon is performed. I do not wish to minimize it, but it is a very small surgical procedure easily and quickly accomplished.
It is a matter of experience, clinical judgment and findings after careful examination of what should and should not be treated. Perhaps in an individual who has one or more problems they all should be treated, but it is a matter of good judgment about which one should be treated first or which is the main culprit or problem in each individual.
Related Topics:
Technorati Tags: carpal tunnel syndrome, elbow injury, neck injury
50 Comments:
I have been cutting, styling,and coloring hair for 10 yrs. after 5yrs. of doing hair i started with pain in and around my right thumb area along with tingling and numbness in both pinkie, ring fingers and middle fingers. Could this be because of what i do for a living? thankyou robin
Try looking up De Quervains Tenosynovitis
A programming career is supposed to offer advantages such as longevity and limited physical risk. Unlike an athlete or blue-collar worker whose livelihood depends on physical ability and can be cut short by injury or aging, most programmers should expect to work right up until retirement, as long as they can raise donut to mouth. But a nasty secret in the software industry is how repetitive stress injuries including carpal tunnel and cubital tunnel syndrome can make programming a literal pain and threaten your career.
http://www.devtopics.com/programmers-nightmare-cubital-tunnel-syndrome/
i have had 12 surgeries due to corpal tunnel syd. need more but drs wont, each 1 causes more problems. soo, much pain, hands, legs, foot and back. don't know what to do.
I broke my wrist,after the cast came off they told me,I have Carpal Tunnel. My Question is when I get a manicure I always get a Parafin Dip is this harmful or add pain to my carpal tunnel. Thank you Laura
This is a good educational description of the types of repetitive strain injuries that are prevalent in many occupations, from production to data entry. Trigger Finger, Tennis Elbow and Carpal Tunnel Syndrome are quite common in the 21st century, plaguing millions of people each year. It is important that those suffering with these forms of injury utilize conservative stretch and exercise therapies before undergoing invasive treatments like cortisone injections or surgery.
How long will u be off after carpal tunnel surgey?
help my thumb is killing me what will help
Lynn,
If you are experiencing severe pain, you should make an appointment to be seen by your health provider as soon as possible. Our health professionals cannot make a diagnosis over the internet.
For more information about managing symptoms of carpal tunnel syndrome, click here.
for several months now i have been having severe pain from my right shoulder all the way down to my fingers,I haven't slept a full night in months.I have been to 2 doctors.The pain medicine is not working. HELP
My husband is a professional drummer. Over the past two years, he has been slowly losing range of motion in his right hand. He assumed it was due to over or under use, etc. Over the past six months, he has had to slowly stop playing because now his hand cramps up and his wrist is totally locked (put a pen in your hand with the thumb on top of the pen and hit your desk, that 'downward motion he can no longer make, his wrist just 'stops' and he can't make it move down). He's seen a neurologist and an orthopaedist. Both say it's a nerve in his elbow and he needs surgery because prolonged rest hasn't helped. He has no pain. Any ideas on what type of doctor we should see next or a possible diagnosis?
I've been diagnosed with compression of the ulnar nerve. Problem is I have no or very little numbness and really have just one symptom, my left pinkie twitches. It's random, but happens from typing, long bike rides and many hours after rock climbing (never during). It can happen when my core temp goes up, by that I mean when I'm indoors in the winter and have my jacket on just standing there and my chest, arm get hot it twitches. I've read all the ulnar compression posts and I don't have what a lot of people describe. I've seen 2 ortho Dr. and a nerve Dr. Who next?
Past info on my arm:
I did this from over training for rock climbing about 3 years ago I was doing hundreds of pull ups a day along with much indoor rock climbing. I also did one hand pull downs with 200lbs+, very dumb! I noticed my left hand curling up a bit after work outs, but no pain or anything else. I did not stretch much at all. (huge mistake of many) So after months of this one night I went over the top way to many pull ups and the next morning my left elbow was numb, just below the joint on the inside edge of the ulnar bone as it leaves the elbow. I climbed a few more times but stopped for about 6-8 months. during that time I stretched and massaged and iced. slowly I started climbing again and had few symptoms other than the occasional curling or twitching of my pinkie finger kind of like the nerve firing when it was not supposed to.
I have had numbness and tingling in the pinky and ring finger on my left hand for 4 1/2 months now. I had an EMG and was diagnosed with mild ulnar nerve entrapment. I was sent to an orth surgeon who sent me for iontophoresis w/ Dexamethasone treatments - I had 5 with no effect. I've used splints at night with no effect. I'm worried about nerve damage and wonder if surgery wouldn't be the solution? Not that I advocate surgery if it isn't needed.
I had carpal tunnel in right hand and a release done 4 yrs ago. Since the surgery I have been diagnosed with mild tendonitis in righ forearm. Still have pain in wrist, forearm and it travels to my shoulder. Had emg on performed and carpal tunnel wasn't the problem. What could be causing these symptoms?
I was in the market today and it was freezing in there. After shopping around for awhile I felt my left index finger go numb. I thought maybe I'm just too cold. When I got to check out I noticed my whole finger was purple and I could not feel anything. It felt like my finger was just dead. I was so scared. When I got into my car, I immediately turned on the heater to warm my finger up. Slowly I began feeling sensation again and my finger was turning normal again. I still don't understand what happened to me.
I am in agony since I awoke last night with pain from under my arm, down my arm, severe to my elbow and palm and fingers. I've taken 4 Lortabs & nothing seems to help. This is my left arm. I've had carpal tunnel surgery in my right hand, and I've never experienced pain like this, which hasn't stopped since last night. Please help.
To the last Anonymous commenter who spoke about being in agony,
You need to seek medical attention as soon as possible. We cannot know what is causing this and there's the potential of it being serious.
Best to be safe and have someone take you to the hospital or call 911.
i've been experiencing numbness and tingling in my left hand (pink and ring fingers) it feels like it stems from my elbow. however i've had lymphnodes removed from this arm in the last 4 years and i have a hard time feeling things correctly. how do you tell the difference between ulnar nerve issues and lymphadema? i'm having swelling and wake up with a hand that's fallen asleep.
Anyone having carpal tunnel syndrome should try exercising the big muscles. Push ups and pull ups. I have problems unless it do those. I also hang from the bar for 15 seconds after the pull ups. Works for me. Also have a hip problem where walking hurt at times last year. I started jogging to work and back which made two short runs instead of one long that had been irregular. Got light shoes also. Was fine for the NY marathon this year. Getting the blood going in these areas seems to be a real key. Also the run to work takes out the decision of exercise or not. Plenty of scaffolding in NYC for a pullup. Faster than the subway and a little slower than the bike. CAB
I worked in a dialysis center for 5 yrs. some of the girls I worked with started experiencing numbness in their hand or aching feeling. I started waking up in the middle of the night with my left hand tingling like it was asleep, I couldn't feel anything. It scared me. I have always opted for a natural cure before surgeries or any medications that just seemed to take away my symptoms. I chose to see a chiropractor. I went to a chiropractor 3 times a week for 3 months, the pain & symptoms were gone. A girl that worked with me chose the other route, surgery & cortizone shots. She continues with the ache. I have since changed careers but use my hands. I am a hair stylist & now am not suffering from the numbness, but a twitching in my left shoulder muscle. I pulled up the symptoms & it took me here. So I guess I'll be back to the chiropractor! But, honestly before you go thru the pain & discomfort of surgery, you might try chiropractics. It only makes sense. Compression on the nerves is going to do just this...numbness, twitching, pain. Its alot less invasive, and you can continue to work with treatment. Good luck to all who ache!!
for the last 6 months haven't been able to sleep much, only 3 hrs a night.both my hands go numb on me ,but the right hand is the worse.its so bad i want to cry. durin the day it comes an goes,driving is tough writing,and trying to work all day. need some ideas what it could be .
I have a question. I have been diagnosed with mod-severe carpal tunnel in my right wrist/hand. My ortho doc wants to try another cortisone injection. I just want it fixed.
My question is, has anyone experienced cold fingers in the area affected? My thumb and 3 fingers are affected, numbness, tingling, burning palm etc but I have yet to find anyone who experiences the cold digits.
thanks!
I will feel strain in my left wrist from time to time, with sharp pain when I do pushups, and dull pain at rest. When I put it in a splint and concentrate on limiting motion, it goes away after about 4 weeks...but inevitably comes back. Does this sound like a possible case of carpal tunnel, or some other problem?
Months ago I attemped suicide by cutting deep down in my wrist. I had 15 Stichies in my wrist. I am now seeing a psych. Since I cut my wrist I have been having alot of numbness, tingling and weakness in my hand. I have problems from the tip of my fingers to me elbow. could I have cause this by my suicide attempt. should I seek professional help. Or will this go away on its own. It's been over 90 days, and the pain will not go away.
i just had cubital tunnel surgery- prior to surgery i had what many people are describing- numbness and tingling in my pinky/ring fingers, and also pain in my wrist and up toward my elbow. i am a cellist so that was a problem. i tried almost everything including cortisone shots and acupuncture but nothing worked. now i am recovering from surgery- the numbness and tingling are pretty much gone and most of the pain is gone, i'm slowly returning to activities. hopefully this info is helpful for some people considering surgery.
i can really relate to alot of u, i thought something really was going wrong, for the past year when i sleep my hands and fingers get so numb and so swollen that it hurts i can't sleep, they feel like balloons, sometimes its just my hands and sometimes its my arms to can barely move them,i don't have health insurance and with so many people telling me it could be a blood clot, or something more serious i began to worry more, but after reading ur posts i feel a little relief, but what can i do to rid the pain??
I have noticed that my fingers in my right hand has been going numb, mainly my thumb and all my other fingers but not my pinky. It used to last only a few minutes and I could shake my hand or rub my fingers and the tingling would go away, not now they remain tingling for 30 minutes or longer and it is so painful. It only begins in the night, it wakes me up several times in the night as befor it only woke me once, why does it hurt so bad? Why does it last so long now? Please help me with these answers.
I had a crushing tear to my right thumb with a skid loader 3/1/04. I had gone two years seeing doctors with pain all the way up my arm to my chest. After test I ended up having surgery for a neuroma at the base of my thumb and a carpal tunnel release. The pain increased to both sides of my hand and up my arm to my chest. After another year of seeing doctors it was decided it was the ganglion nerve that was damaged. I had a spinal cord stimulator implanted from the base of my spine down to my buttocks where the battery is implanted. Now my ring and middle finger are locking down tight.Are they related????
I had CTS surgery on my left hand in September 2007. Was supposed to have my right hand done. Waiting on that at the moment. I went to the Ortho doc today. Still have the pain, numbness and tingling in my left hand. The loss of strength is awful. Still have troubles lifting a gollon of milk. So now Im off to getting another Nerve Conductive Test done. He said that he does not know why I am still getting these symptoms after 4 months. Anyone have any clues?
I had carpal tunnel synd. sugery last week; feb.7th,08.my pinky and 4th finger were black and blue,plus my arm underside to the elbow. also had and still have mild swelling and a hives red rash on the right arm only.And plenty of pain Ive never experienced.My doctor mentioned neuropathy... are my nerves damaged permanently?ll see my doc. Feb.20th,08 in which the stitches will hopefully be removed.I imagine my doc. will refer me to a neurogist. any comments of knowledge of what to do or not to do....MUCH THANKS! cherell
First my right pinky finger became very sore and I don't know why. It did not get much better and after several weeks has a swollen knot at the larger joint. Now for no apparenr reason the pinky finger on my left hand is in pain in the same location. I use a laptop daily and do not use either pinky to type with. I kind of hold them out as I type. What is the cause/cure?
i type alot every day. i just recently got deep pain in my left hands palm right in the center and in my wrist. and it hurts to type with my left hand. someone suggested i may have carpal tunnel. i looked it up on here and im not sure, i dont have tingling or burning or anything, just deep pain. but i thought i may not have it because im only 16 years old. what do you think
thankyou rachel
can you get carpal tunnel from someone grabbing your wrist all the time. - tightly, squeezing it out of anger. i have extreme pain in my upper left arm and twitiching in both my arms.
carpal tunnel is no joke. I have severe CTS along with a broken bone in my left hand(hamei) the pain at night was unbearable, but worse is the progressive atrophy of the muscles of the hand, resulting in a "claw" appearance. I had a top hand surgeon in NYC operate and correct it, but the damage is irreversible. I just had CTS release in the right right hand and ulner release- because the ulner nerve was pinched, causing numbness in the pinky and ring finger. Someone on this blog said CTS was the "buzz word" of the 90's and 21st century. I disagree. If an EMG verifies CTS, etc, find a hand specialist and sop the progression.
Tracey says her left hand painfull , last 3 didgits cold pain in left arm ,elbow,shoulder, neck. all on left side is this possible carpal tunnel, n c4 pain, what is the procedure n how is it done.
I am a tech in a hospital.for the last month I have been having pain in my right fore arm and fingers. I am on medical leave for it.The doctor said it's not be having as typical carpal tunnel. I am in a wrist brace,and still off of work.He said it would be painful wearing the brace.I had a nerve test done and it came back good. The only typing I do is at home. I left people and push and pull people on and off stretchers,I do cpr,made beds,restrain people.I can't left a gallon of milk right now.
my husband has trouble with his left arm and hand going to sllep on him during yhe night. Anyone know why this is happening
In regards to Rae, who is on medical leave and can't even lift a gallon of milk. I have the same symptons. Mine is in my hands and when I use any strength to them I will loose feeling in my arms. My was onset suddenly 14 years ago. I have seen all types of specialist and they still can't figure out what the problem is. My Doctor is now wanting me to go to the Mayo clinic for research. Good luck and keep me posted.
Malisa
Lately I have been cramping in my right hand. My thumb and index finger will lock (like giving the "OK" sign). It is quite painful and usually lasts about 30 minutes. This always happens after lunch. I work in a laboratory and it hinders my work. I cannot seem to find a cause. Any advice or help anybody can give would be appreciated.
For over a year now whenever I grip something when left or right hand, my fingers will lock up or become stiff for a few seconds. It seems the harder I grip something, the stiffer they become.
I've been doing hair for many years, I have carpal tunnel for many years [20-30 yrs.] in both hands, also 4 trigger fingers & both thumbs. My finger are now beginning to curl up like a hook. The curling was at night until about lunch, now I can't straighten them up at all. The pain runs up to my neck. My hands hurt all the time, I never sleep more than 1 hr, at a time and pain is constant now. I have excruciating pain at night & my fingers tips turn blue. I can't afford an operation even though I have insurance. I'm afraid I will lost the ability to use them if nothing is done soon. I can't afford to stop work but If I did stop now can I save my hands with or without surgery?
I am a mom of 5 and I used to get this horrible numbness in my arms and hands when I slept and now my last baby is one and it is happening again. I am waking up a lot during the night because my arms and fingers are going numb and the pain going all the way up to my elbow is so bad. Could this be carpal tunnul? All I know is that it hurts and I cannot even write or hold a cup in the morning when I wake up. Please help!!!
I always wonder why the medical community thinks that releasing the median nerve will fix anything. It doesn't deal with the source of the problem. -Something- made the carpal tunnel structure get compressed. How does surgery deal with that?
Yes Robin, repetitive hand motions from cutting hair, and your work posture, are classic culprits for creating a dynamic of wrist pain and finger tingling/numbness.
No pain here, just numbness and tingling in pinky and ring finger, left hand - medical transcriptionist - symptoms while typing and wake up at night with them. Same symptoms MANY years ago, was given physical therapy/ultrasound therapy, hand brace, exercises, and ergonomic 'checkup' for office setup.
Looking for something to try before going to the doctor - any ideas?
Great blog!
My husband is a tree trimmer, the term Trigger finger works here.. Both of his arms have been numb for the last two weeks. What is going on.. HE also has hypo-thyroid and haven't been able to take his med. Is this a condition of that?
To Tanya: EMG may help give insight- may have permanent damage of nerve which were not reversed by C.T. surgery.
To Anonymous who had CTS surgery: Black & blue is blood under skin- not unusual to have some blood escape- carpal tunnel very vascular presumably not major vessel or nerve injured. Expect some improvement.
To Anonymous with sore right pinky finger: I'm not sure about your 5th (pinky)fingers. Check with your doctor.
To Rachel: Deep localized pain not typical of CTS- more typical of ligament pr bone problem. Check with your doctor.
To Anonymous with extreme pain in upper left arm: Traumatic episode may set off CTS - but what you describe not usual.Check woth doctor. EMG test will document CTS.
To Anonymous: I said CTS is the "Buzz" word of the 90's and 21st century because of its increasing frequency- but you give good advice.
To Katherine: People with CTS do report pain usually radiates from wrist up forearm and hiogher- not usual. Important you discuss with your neurologist. Carpal tunnel release surgery may be worth a try.
To Anonymous asking about bones and tendons affected by CTS: Not that kind of proble. It is compression of median nerve which causes pain, nmbness, ands sometimes weakness of hands. Small muscles in hands are most affected.
To Anonymous whose husband has numbness in the tip of his middle finger: Check wuth doctor finger tip pain- maybe nerve problem or vascular problem. Does he smoke?
Hi I'am a 37 year old diabetic type 1(insulin dependant)since 1983
I had an Electrophysiology test(EMG) they said that abnormalitirs of nerve conduction studies and late responses demonstarte dispersion of ulnar and median nerve F-waves on the left.Motor potentials reveal diminishment of left ulnar and median nervesas they cross the wrist.Sensory potentials are of extreme low amplitude n the left.Neddle electromyography of distal groups reveals denervation/reinnervation potentials at C-6-7 levels bilaterally.Right C-7=T1 levels shows increased membrane irritability.
The Conclusion was:Electrophysiologic evidence of C-7 nerve root entrapment bilaterally.
2-Lesser evidence of nerve root membrane irritability at right C-8 nerve root-without frank proximal denervated potencials.
3-Left ulnar and median nerve neuropathic conduction loss.
They recommended Clinical and MRI correlation.(what does it mean?)
can anyone help me understand all of this in plain english if possible what is really wrong with me?what can I do?
I have a problem too which baffles me, 3 months ago I had bad pain in my lower arm which ccaused my pinky and the side of my left hand to go numb, I went to walgreens and bought a brace and took Aleve for the pain , Now I am pain free but my pinky is still pins and needles numb with feeling and the side of the hand below it and has been like this for 3 months with no improvement. Any ideas what this could possibly be? I do not have any health isssues.
I suffered from carpal tunnel syndrome from 1995 to 2006. At first my I would feel pain on the outside of my thumb to my wrist. I had a nerve test performed and it was determined that I had bilateral carpal tunnel syndrome in my left and right hands/wrists. After years of pain, my fingertips became very numb to the point where I had no feeling. I had more nerve tests done in 2006 and was told that I was close to the point of having complete nerve damage. I was told that I would eventually lost the use of my fingers. I finally had carpal tunnel surgery done in February 2006. After the surgery, the numbness and tingling went away. Now in 2008, I am experiencing another problem with my right hand called "trigger finger". This is very painful. The synovium part of my right middle finger (under my knuckle) is so swollen. When I bend my middle finger and then try to straighten it out, it snaps like a trigger on a gun. Some days my finger gets stuck and I have to straighten it with my other hand. My doctor injected cortisone into the shaft of the finger, but it only helped for a month. I am scheduled for surgery to relieve the pressure off of my finger.
Im 23 years old and i started feeling alot of pain in my right wrist about 4 months ago. my orthopedica says its carpal tunnesl syndrome and is sending me to a neurologist to make sure he is correct. do you knwo what kind fo tests they will do?? and because i am so younge will the surgery help if i elect to have it instead of the cortizone shot??
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