Carpal Tunnel & Other Nerve Problems

Carpal Tunnel Syndrome
If you experience intermittent or persistent pain, tingling, weakness, or numbness in your hand, you may have carpal tunnel syndrome. The carpal tunnel is a narrow, rigid passageway on the palm side of your wrist. The median nerve, which controls feeling and movement in the thumb and first three fingers, runs through the carpal tunnel, along with tendons that run from the forearm to the thumb and fingers. Carpal tunnel syndrome occurs when the median nerve is pinched or compressed in this tunnel.
 
Symptoms of carpal tunnel syndrome tend to develop gradually and often first appear during the night or when waking. Some people sleep with their wrists flexed in a positon that puts pressure on the nerve, making the symptoms worse. The first symptoms are often tingling – that “pins and needles” feeling – and/or numbness that can be alleviated by shaking the hand. As the syndrome progresses, the tingling and numbness may increase and be felt more often throughout the day. Decreased strength and sensitivity may make it difficult to perform manual tasks, such as grasping small objects, working with tools, or buttoning a shirt. Some patients experience pain in the hand and wrist, which may radiate upward into the arm.
 
Conditions that may contribute to carpal tunnel syndrome include:
  • Injury to the wrist
  • Rheumatoid arthritis
  • Diabetes
  • Gout
  • Hypothyroidism
  • Fluid retention during pregnancy
  • Repetitive motion that causes pressure or inflammation in the wrist
  • Development of a tumor or cyst in or near the carpal tunnel

Women are three times more likely to be affected than men. It can occur in one or both hands, and usually starts in the dominant hand.
 
Treatment
If you haven’t had the symptoms very long, treatment can begin with immobilizing the wrist in a brace or splint. Ice packs and non-steroidal anti-inflammatory drugs are often recommended to relieve discomfort and inflammation. For severe symptoms, corticosteroids may be recommended. Once the symptoms have abated, your doctor may recommend physical therapy to stretch and strengthen the hand to keep it strong and mobile.
 
Some cases may require surgery on the ligament overlying the carpal tunnel. Cutting the carpal ligament relieves pressure by enlarging the opening. The surgery is performed under regional anesthesia and sedation in an outpatient facility.
 
For more information, see the website of the National Institute of Neurological Disorders and Stroke.

Other Nerve Problems
Cubital tunnel syndrome and radial tunnel syndrome aren't as well-known as carpal tunnel syndrome, but they can cause similar symptoms due to increased pressure on nerves in the hand, wrist or arm. Cubital tunnel syndrome and radial tunnel can cause severe pain, numbness, tingling, and muscle weakness in the hands and arms.

Cubital Tunnel Syndrome
Cubital tunnel syndrome, also known as ulnar neuropathy, is caused by increased pressure on the ulnar nerve, which passes close to the skin's surface in the area of the elbow commonly known as the "funny bone." You're more likely to develop cubital tunnel syndrome if you repeatedly lean on your elbow, or bend your elbow for long periods of time.

Some of the early symptoms of cubital tunnel syndrome include pain and numbness in the elbow, and tingling, especially in the ring and little fingers. More severe symptoms may include weakness affecting the ring and little fingers, decreased ability to pinch the thumb and little finger, decreased overall hand grip, muscle wasting in the hand, and a claw-like deformity of the hand.

Radial Tunnel Syndrome
Radial tunnel syndrome is caused by increased pressure or compression on the radial nerve, which runs by the bones and muscles of the forearm and elbow. The radial nerve is one of three nerves that provide motor and sensory function to the arm.

Conditions that may contribute to radial tunnel syndrome include:
  • Injury
  • Noncancerous fatty tumors (lipomas)
  • Bone tumors
  • Inflammation of surrounding tissue
The most common symptoms of radial tunnel syndrome are cutting, piercing, or stabbing pain at the top of the forearm or back of the hand, especially when you try to straighten your wrist and fingers. The pain is located in the forearm a couple inches below the elbow. Unlike cubital tunnel syndrome and carpal tunnel syndrome, radial tunnel syndrome rarely causes numbness or tingling, because the radial nerve principally affects the muscles.

Treatment
Mild cases of cubital tunnel syndrome often respond to physical therapies such as, avoiding pressure on the elbow, wearing a protective elbow pad, or wearing a splint. In cases where splinting doesn't help or nerve compression is more severe, surgery to release pressure on the ulnar nerve may be needed.

Conservative treatments for radial tunnel syndrome include medications such as nonsteroidal anti-inflammatory drugs to reduce soft tissue swelling, corticosteroid injections to relieve inflammation and pressure on the radial nerve, and wrist and/or elbow splints to reduce irritation of the radial nerve.

Some patients also may benefit from ergonomic education to reduce the effects of repetitive stress, nerve-gliding exercises, stretching/strengthening exercises, and other interventions such as heat, cold, and ultrasound. If these conservative measures fail to provide relief after three months, your doctor may consider surgery to reduce pressure on the radial nerve.

In most cases, cubital tunnel syndrome and radial tunnel syndrome can be managed with conservative treatments. But more severe cases may require surgery to reduce pressure on the affected nerve.

For more information about cubital and radial tunnel syndrome, visit the following website: http://www.webmd.com/pain-management/cubital-radial-tunnel-syndrome#3.
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