Is this Carpal Tunnel Syndrome?

With all the time we spend at computers, I'm amazed we don't actually see more complaints of carpal tunnel syndrome (CTS), the single most common cause of peripheral nerve compression. Carpal tunnel symptoms include pain, numbness or tingling of your THUMB, INDEX, and MIDDLE fingers, and may extend to include your wrist, palms and forearms. Typically, the pain is worse at night, although that is not true for every person. Extended use of your wrists or hands- such as typing at a computer- also tends to increase discomfort.

The actual problem in CTS is pressure on the median nerve at the wrist. The median nerve only supplies the thumb "side" of the hand and fingers, which is why the symptoms do not show up in the pinky finger. (If the pinky is numb or tingling, you may be pressing on the ulnar nerve at the elbow).
The space in the wrist is limited- restricted by a ligament on the bottom and bones up above, so even general fluid retention and swelling can cause compression and lead to carpal tunnel symptoms. Pregnancy, for example, often results in enough fluid retention to cause CTS. Other risk factors include diabetes, kidney failure, low thyroid and birth control pill usage, as well as jobs or activities that result in prolonged flexion or vibration of the wrist, such as golfers, carpenters, musicians, jack-hammer operators and assembly line workers or grocery clerks.

There are a couple simple tests that doctors use to help diagnose CTS. Tapping on the underside of your wrist may cause a shooting electric pain to jump up into your wrist or palm- that is called the Tinel sign. Holding your hands together, bent downward (like reverse prayer hands) can worsen the numbness, pain or tingling in your thumb and first two fingers- this is the Phalen's sign.

Treatment obviously varies depending on the cause of the CTS. If the primary cause is fluid retention from another medical problem or medication, then treatment will target those issues. Prescription strength ibuprofen or similar anti-inflammatory medications have traditionally been used to provide relief of symptoms, although the scientific evidence is lacking to support this approach. Various splints are available and have been proven to provide some relief when worn consistently at night. Local steroid injections into the wrist have definitely been shown to be effective for at least short-term relief of symptoms (compared with placebo). Physical therapy and avoidance of behavioral triggers play a significant role in treatment. Finally, a minority of CTS cases may require actual surgical decompression to improve symptoms.

BOTTOM LINE: If you are having persistent or recurrent numbness, pain, or tingling in your thumb or first few fingers, head to your family doctor for a definitive diagnosis- don't wait until the symptoms have been stuck there for months, because the longer you've had symptoms, the more difficult it is to cure.

Is Your Pinky Tingling?

Have you ever had your pinky go numb or start tingling, especially at night? If so, did your co-worker tell you it might be carpal tunnel syndrome? Hmm...probably not the right diagnosis. Although carpal tunnel syndrome also involves fingers starting to tingle or go numb, that problem is associated with the median nerve, which supplies your thumb and first three fingers (and half of your ring finger.) If your PINKY gets involved with the tingling, that is due to the nerve on the other side of your arm- the ulnar nerve.

Cubital Tunnel Syndrome, also known as Ulnar Neuropathy, results from pressure or compression of the ulnar nerve at the elbow. Men suffer from this problem much more than women, anywhere from 3-8 times more often. What causes this? Sleeping with your elbows bent and arms overhead (scrunched up under your pillow as a side-sleeper) is a common cause. Athletes who have repetitive upper arm motions such as throwing, hitting with a raquet or skiing can also suffer from this problem.

The primary prevention is to avoid prolonged periods with pressure on your elbow. For example, if you are driving a long distance, be careful not to prop your left elbow on the arm rest (putting pressure directly on the side of your elbow) for extended amounts of time. If you are a side sleeper, try not to extend your arms over your head.

Treatment depends on the severity and duration of symptoms. Many cases can be treated with NSAIDs (like ibuprofen) or a simple steroid injection into the elbow, coupled with the avoidance behaviors noted above. Bracing at night, physical therapy and ergonomic corrections to computer desks go a long way towards correcting and preventing future injuries. A minority of cases are so severe that they do indeed require surgery, but 85-90% of all cases of cubital tunnel syndrome will resolve with good to excellent results.

BOTTOM LINE: All that tingles (in fingers) is NOT carpal tunnel- if you have persistent pain, numbness or tingling in your ring finger, pinky , or forearm, you may be suffering from another compression syndrome such as Cubital Tunnel Syndrome.