by Barry S. Mann, M.D.

Many people dismiss hand pain as a sign of aging or arthritis instead of getting treatment for a condition that could cost them the full use of their hands: carpal tunnel syndrome (CTS).

The carpal tunnel is a narrow passageway in the wrist that is surrounded by wrist bones and a ligament that links the bones together. This passageway protects the median nerve to the hand. Tendons that operate the fingers also pass through this tunnel. CTS occurs when the tunnel gets crowded, either because tendons become inflamed or thickened due to repetitive hand use, or due to genetic smallness of the carpal tunnel. When the median nerve is compressed in the tunnel, it can cause pain to radiate from the wrist, followed by tingling or numbness in the fingers, and a weakness in the hand.

Unfortunately, people often mistake the signs of CTS for tendonitis or arthritis, and may live with the pain of this degenerative disease for several years before seeing a physician. Meanwhile the injured hand has grown steadily weaker and they risk permanently losing their grip strength. If addressed in the moderate to mild stages, where there is pain but minimal weakness or tingling, CTS is very treatable.

CTS came into the spotlight with widespread computer use in the 1980s, as office workers began reporting hand pain from constant keyboarding. However, recent research is suggesting that excessive typing will only cause CTS in people who are genetically susceptible to it, because people with a small carpal tunnel are more likely to develop the condition than those with a larger tunnel, even in the absence of repetitive hand use.

To diagnose CTS, doctors will first measure a person’s wrist and grip strength, and check for any loss of sensation in the median nerve. To confirm the diagnosis, neurologists conduct an electrical test called an electromyogram, which determines how well the median nerve transmits signals through the carpal tunnel and up the arm.

Fortunately, CTS responds well to treatment, especially in its early stage. About one-third of those diagnosed with CTS benefit from using splints to keep their wrists stationary while sleeping; and corticosteroids can relieve pain. Yoga and acupuncture are also helpful to some patients at this stage; however, anti-inflammatory medications are not particularly effective.

Outpatient surgery, which cuts the ligament pressing on the median nerve, helps a vast majority of CTS patients regain full use of their hand within weeks. About 10 percent of patients may not respond to surgery, and when the condition advances to a severe stage, surgery may only offer a small degree of improvement.

Instead of allowing CTS to progress and cause long-term damage, anyone experiencing hand pain that does not rapidly respond to over-the-counter analgesics should consult with a neurologist for a complete examination.


Dr. Mann is a neurologist specializing in neuro-muscular disease. He is affiliated with Eden Medical Center in Castro Valley and San Leandro. Dr. Mann can be reached at (510) 886-7122.