Ask the Pharmacist

Q) I have been getting some tingling pain in my wrist, off and on again, for some time now. It’s been getting worse so I saw my doctor the other day and she said I had carpal tunnel syndrome. I have heard of this, but I don’t really know much about it. What can you tell me?

A) Carpal tunnel syndrome is an incredibly common condition that most of us have some knowledge about (i.e. it involves the wrist, people who type get it a lot…) but lack the specifics when it comes to its physiology, symptoms and treatment. Hopefully we can address those in the next few paragraphs.

Let’s start with just how common carpal tunnel syndrome is. In the U.S., it is estimated that it affects between 3 to 6% of adults in the population with it being three times more likely in females than in males. The chances of developing this increases with age and as such, it is unlikely to be seen in those under the age of 20.

While many associate this injury with repetitive stress type jobs that involve using one’s hands (such as typing), the largest risk factor for being diagnosed with this condition is having a family history. Small carpal tunnels tend to run in families and a small carpal tunnel makes this condition much more likely. Other risk factors include pregnancy, which can cause swelling in the wrist area, engaging in activities that require extreme hand or wrist flexion/ extension for a prolonged period of time (such as rock climbing) and certain health conditions such as diabetes and rheumatoid arthritis.

The condition gets its name from a narrow passageway in your wrist. The carpal tunnel is about an inch wide and its four sides are made of rigid materials (carpal bones and strong ligaments) that have little ability to expand or stretch. Within this tunnel runs our median nerve along with the nine tendons that when triggered bend the fingers and thumb. The median nerve allows for feeling in the thumb, index finger, middle finger and half of the ring finger (hence the pinky and the other half of the ring finger are never affected by carpal tunnel syndrome since they are supplied by the ulnar nerve). Carpal tunnel syndrome occurs when the tunnel becomes narrowed or, more commonly, when the tissues surrounding these 9 tendons swells, putting pressure on the median nerve and reducing its blood supply.

Symptoms of tunnel carpal syndrome include:

· Numbness, burning, tingling and/ or pain- usually in the digits mentioned above and often severe enough to affect sleeping.

· Pain or tingling that may travel up the forearm, possibly all the way to the shoulder.

· Occasional shock-like sensations that radiate to the thumb and the three fingers supplied by the median nerve

· Weakness or clumsiness in the functioning of the hand (typified by dropping things more often, having problems with routine tasks such as buttoning a shirt…)

In general, these symptoms begin gradually without any specific injury causing them. Initially they tend to come and go but as time goes on, they tend to occur more frequently or persist and their severity increases. Symptoms tend to be worse at nighttime (since many people sleep with their wrists bent putting extra pressure on the nerve) or when holding something for a prolonged period with their wrist bent (such as holding a book or a phone). Moving or giving one’s hands a shake tends to temporarily improve the symptoms.

Like many injuries or diseases, if carpal tunnel syndrome is addressed in its early stages, the progression of the disease can be stopped or at least slowed without the need for surgery. The mainstay of treatment is the wearing of a rigid wrist brace at night that prevents the individual from bending their wrist and thereby worsening the swelling while they sleep. These are relatively inexpensive (under $50) and offer no real downside. Anti-inflammatories (i.e. the NSAIDs such as ibuprofen/ Advil, Aleve/ naproxen and others) can help reduce the swelling in the wrist while also relieving the pain. There are also nerve gliding exercises that can be performed that can help the median nerve move more freely. Talking to an occupational therapist may allow for modifications of your activities at work (or home for that matter) that may be playing a role in aggravating your condition.

A combination of some or all of these conservative treatment options can often permanently treat carpal tunnel syndrome on their own if they are started early enough. However, if these measures fail to adequately relieve the symptoms, the next step is usually a cortisone injection directly into the wrist. It offers additional potential to relieve the symptoms, potentially permanently, if tried early enough. If none of these options help enough, surgery is a potential solution. It is done on an outpatient basis and recovery tends to be gradual with a complete recovery possibly taking up to a year.

Failure to take any measures to treat this condition can lead to permanent nerve damage resulting in a loss of sensation/tingling or weakness of the fingers. In cases such as this, surgery may improve these symptoms to some degree, but full restoration may be impossible.

This is yet another reminder to listen to what your body is telling you. Pain is a signal that something is wrong and if it persists or worsens, visiting your doctor sooner rather than later can benefit you in more ways than one. For more information about this or any other health related questions, contact your pharmacists at Gordon Pharmasave, Your Health and Wellness Destination.