Carpal tunnel syndrome and finger swelling

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Carpal Tunnel Syndrome (CTS) is a condition that causes numbness and pain in the hand and arm.

CTS becomes worse with excessive or repetitive use of the wrist. The carpal tunnel is a channel in the wrist formed by eight carpal (wrist) bones, which consist of the floor and sides of the tunnel, and the transverse carpal ligament, a strong ligament that forms the roof of the tunnel.

Within the carpal tunnel are nine tendons. These tendons connect the muscles of the forearm to the fingers and thumb. As the forearm muscles contract, these tendons help bend the fingers. One other important structure in the carpal tunnel is the median nerve which supplies nerve fibers that provide sensation to the thumb, index and middle fingers, and half of the ring finger. When carpal tunnel syndrome occurs, the carpal tunnel contents can swell and the patient will experience “pins and needles,” numbness and aching in the fingers due to pressure on the median nerve.

Carpal tnnel syndrome can be caused by a variety of problems. Multiple medical conditions that lead to compression of the median nerve include:

• Tenosynovitis (inflammation or swelling involving the tendons) not only causes carpal tunnel syndrome but also may cause swelling in the fingers
• Fluid retention which may be accompanied by finger swelling
• Wrist fractures and dislocations
• Crush injuries
• Rheumatoid arthritis causes significant tenosynovitis as well as swelling and pain involving the fingers
• Other types of arthritis such as gout and pseudogout which can also cause finger swelling
• Diabetes
• Tumors
• Hypothyroidism
• Pregnancy which causes puffiness of the fingers because of fluid retention
• Repetitive motion or excessive pressure on the carpal tunnel

The most common cause of carpal tunnel syndrome is probably tenosynovitis of the tendons in the carpal tunnel. This causes swelling of the tendons and puts pressure on the nerve. Repetitive use of the fingers and wrist also causes swelling and an increase in pressure in the tunnel. The fluid retention that accompanies pregnancy causes pressure on the median nerve and can lead to the symptoms of carpal tunnel syndrome.

Work activities that involve repetitive motion aggravate and produce carpal tunnel. Non-work related activities that also involve repetitive motion such as lawn mowing; long-distance driving; knitting; and wood carving may also cause symptoms of CTS.

Numbness, burning, or tingling of one or more fingers (excluding the little finger) is the most common symptom of CTS. The pain and numbness can happen at any time, but it often occurs at night and may awaken the patient from sleep. At times, the pain may extend up the arm, into the elbow, and as far up as the shoulder and neck. Shaking, massaging or elevating the hands can sometimes provide partial relief. Some patients will drape their hands over the side of the bed.

On the palm side of the hand, just below the thumb, is a piece of muscle called the thenar muscle group. These muscles are controlled by the median nerve. With CTS, this muscle group may begin to atrophy.

An accurate history of the onset and duration of symptoms is very important. Several diagnostic tests will be done during the examination that usually recreate the symptoms of numbness and tingling. Magnetic resonance imaging will be required if there is a possibility of diagnosing carpal tunnel syndrome. Specific laboratory tests may be indicated if a medical condition is suspected. Many patients are referred for electrical tests (nerve conduction and electomyograms-EMG) to make sure that there are no other sites of compression of the median nerve.

Sometimes the symptoms can be relieved without surgery. Non operative treatment includes avoiding repetitive use of the hand and keeping the wrist in a neutral position with a splint. Most patients sleep better if the splint is worn at night. Non steroidal anti-inflammatory agents decrease the swelling around tendons and may help patients. An injection of cortisone into the carpal tunnel can also relieve the symptoms.

In cases of severe compression of the nerve or symptoms that persist, surgery may be necessary to open the carpal tunnel. Surgical procedures are designed to open the roof of the carpal tunnel and provide more room for the median nerve. Sometimes endoscopic surgery can be performed. The recuperation period is much shorter. The numbness and tingling often disappears quickly but several months are necessary for strength of the hand and wrist to return to normal. Some symptoms may continue after surgery. Returning to repetitive or strenuous work with the hand may cause symptoms to return.

Carpal tunnel surgery, per se, may be a thing of the past. Here’s why…

A much newer and much less invasive technique that has excellent results is percutaneous ultrasound guided release. In this technique, a small needle is inserted using local anesthetic. Using ultrasound guidance, multiple small holes are made in the flexor retinaculum (the tough fibrous roof over the carpal tunnel that compresses the median nerve). At the same time, fluid is injected into the retinaculum to spread and weaken the fibers. At the end of the procedure, the wrist is flexed (bent) and the weakened retinaculum is released. A splint is applied and the patient has full use of their hand by the next day.

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