Carpal tunnel syndrome: symptoms, diagnosis and when to consider surgery

Waking up with a numb hand and having to shake it to make it go away is so common that many people ignore it. It is often the first warning of carpal tunnel syndrome.

What is carpal tunnel syndrome?

It is compression of the median nerve at the wrist, inside a rigid passage called the carpal tunnel, which the nerve and the finger tendons run through. When that space narrows, the nerve is compressed and symptoms appear that progress over time. It is the most common nerve compression in the arm.

What are the symptoms?

At first they are subtle:

• Tingling or numbness in the thumb, index finger, middle finger and half of the ring finger.
• Symptoms at night or on waking, relieved by shaking the hand.
• Discomfort when driving, holding the phone or keeping the wrist bent.

Over time, clumsiness appears, along with trouble fastening buttons or a feeling that objects slip. In advanced stages the muscle at the base of the thumb weakens and wastes away, a sign of more serious damage.

How is it diagnosed?

With the medical history and an exam that includes maneuvers that reproduce the symptoms. Electromyography and nerve conduction studies confirm the diagnosis and show how severe the compression is.

What treatment is there without surgery?

In mild or moderate cases:

1. A night splint that keeps the wrist straight.
2. In some cases, a corticosteroid injection as a temporary measure.

These can relieve symptoms, although in many patients they come back or progress.

When does carpal tunnel need surgery?

When symptoms are persistent or intense, there is weakness or muscle loss, the study shows moderate or severe damage, or conservative treatment did not work. Surgery releases the ligament that forms the roof of the tunnel to take pressure off the nerve. It is short, usually outpatient and well tolerated.

What are the results of surgery?

They are usually very good if it is done before the nerve damage becomes irreversible. That is why the evaluation should not be postponed.

In summary

Tingling in the hand at night should not be accepted as normal: it almost always has a solution, and the sooner it is treated, the better the result.

This article is for information only and does not replace a medical visit. If you have warning signs, go to the emergency room.