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Carpal tunnel symptoms typically include pain, numbness and
tingling. These are the most commonly used words
patients use to describe their symptoms. Other common
complaints include burning, throbbing, or cramping.
These symptoms are typically intermittent and may be
activity related during reading, driving or may awaken you
while sleeping at night. The designation of Carpal
Tunnel as a syndrome implies that it can have varied
presentations
The symptoms of carpal tunnel syndrome may be very severe,
or very subtle. Some people have complaints of very
mild aching or cramping while doing a particular activity.
In other individuals, the symptoms are incapacitating or
excruciating.
Other patients will only notice slow progressive numbness in
the hand(s), without any pain or any crisis type symptoms at
all. These patients often present to a doctor after
considerable nerve damage already occurred.
Symptoms may be limited to just the hand, or may radiate up
the extremity. Numbness usually involves any of the
digits but not typically the small finger (pinky) as this
digit receives its feeling from a different nerve- the ulnar
nerve. Symptoms of numbness and tingling in the small
finger, often with pain or irritation at the medial side of
the elbow is usually due to cubital tunnel syndrome-
compression of the ulnar nerve at the elbow, rather than
carpal tunnel.
The median nerve passes through the carpal tunnel at the
wrist and thereafter sends several sensory branches to the
thumb, index, middle and half of the ring fingers. A
separate motor branch passes to the muscles in the thenar
area of the palm (base of the thumb area). Therefore
the symptoms of carpal tunnel are often mixed motor and
sensory. “Dropping things” is a common complaint
usually caused by cramping or early fatigue of the thenar
muscles, or sometimes because the patient simply can’t feel
what they are holding.
Night time symptoms are present in at least 50% of cases,
and in many of these individuals the symptoms
are only present at night. Other common times
for symptom aggravation is during computer use, repetitive
activities, driving, or reading.
Carpal Tunnel symptoms may be present in one or both hands.
They may affect one side more than the other, or may bother
them equally. The dominant hand is affected more that
50% of the time when only one hand is involved, but when
both hands are involved it is not uncommon for the non
dominant hand to be more affected. One hand may start
with symptoms before the other and sometimes both hands
start at the same time. Some people report having
symptoms for weeks or months before going to a doctor, and
others report symptoms to be progressive over 10 or even 20
years. If you think that you may have carpal tunnel
syndrome it is important to see the doctor earlier in the
condition to minimize the risk of a poor outcome.
Brandon J. Luskin MD
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