"'Doc, I am getting pretty frustrated! Every night I go to bed and it is not long after I'm sleeping nicely that I get jerked awake because my hand feels like I just put it in the electric outlet! It's all numb and buzzing--it is driving me nuts. Then I have to stay up shaking it out. HELP doc!" "Hmmmm....Mr W, you seem to have a popular problem today...come on in and we'll check you over."

Does this sound like you every night? It very well could be. This problem is quite a common one. Carpal Tunnel Syndrome (CTS) is often discovered with a very similar history as Mr. W's. It all has to do with a small quirk of nature where one of the main nerves that supplies the palm of the hand travels under a very strong fibrous sheath at your wrist on the palm side. This is called the Carpal Tunnel. It is literally a "tunnel" at the base of the wrist where the tendons that work your fingers travel. The other thing that travels through this same tunnel is the Median Nerve. It takes care of the nerve supply to your thumb, index finger, middle finger, and the half of your ring finger facing the thumb. The nerve that takes care of your baby finger and the other half of the ring finger does not pass through this tunnel and is unaffected. That is why CTS does not typically involve the little finger. Try it and see for yourself the next time it happens to you. Your little finger will be fine, the rest of your fingers will not be.

How does CTS work? Or should I say...not work? Here is the basic physiology of the whole thing. That little tunnel where all those tendons and that one nerve pass through is a very strong tube of sorts. Three sides of the tunnel are made of bone, the roof is a strong fibrous material--so it has pretty much no flexibility for expansion. If you do repetitive activities with your hand, or sustain a lot of vibration to your hand regularly, the tendons passing through that small tunnel will become irritated and inflamed. Now imagine a small and already close quarters type of tube enclosing all of that--where there is barely enough room for all of it to function properly when there is absolutely nothing wrong with it...

Then, as the inflammation worsens, there is less and less room in that little tunnel for the nerve to sit freely and it becomes compressed by all the structures around it. Any compressed nerve is a very unhappy camper while it is happening. So this begins to cause you to feel numbness and tingling in your thumb, index finger, middle finger, and half of your ring finger. As it worsens even more, the symptoms increase and you may even feel electric types of impulses (or maybe even weakness) in the same areas that can be very irritating if not outright painful.

Now here is where the sleep part comes in. The worsening of symptoms in the hand is usually provoked by a sharp bending of the wrist as this increases the compression on that poor little nerve. So when you  sleep, no matter how hard you try, it is nearly impossible to sleep exactly correct all night long. The correct position being a completely straight wrist for CTS prevention. We all eventually sleep on our wrist or bend it in our sleep somehow. This is usually the last straw for our poor wrists and Median Nerve. The nerve becomes much more irritated and after being kept in that position for a certain amount of time, we wake up grumbling and shaking our now "sleeping" hand until the symptoms go away. We will repeat this procedure several times every night until we reach the breaking point and go to see our doctors.

I need to point out here that although there is a usual general speculation that repetitive activities, repetitive gripping, excessive vibration to the hands has been often blamed for the exact "cause" of CTS--the actual discussion is still not over and is apparently not clearly proven yet. None the less, these activities do hold a very key role in the development of the syndrome.

One other important point--although the numbness and other irritating symptoms of CTS seem purely an annoyance, they actually raise the red flag in terms of future problems. By this I mean that ignoring the signs of carpal tunnel and allowing them to persist unevaluated may eventually lead to more permanent nerve damage to the hand that can include weakness and loss of use of the hand muscles. So it is not a condition to be ignored.

What are the symptoms of carpal tunnel syndrome?

• Early symptoms can first appear while sleeping or gripping objects
• Numbness, tingling, burning, or shooting pains in the distribution of the Median Nerve--thumb, index finger, middle finger, part of ring finger
• The affected hand seems to "drop things" often
• Sometimes advanced cases may show evidence of a weakened grip--especially of the thumb
• There may be some evidence of muscle thinning or atrophying at the fleshy part of the thumb in the palm

If you are having any of these symptoms, it is best that you visit your health care provider as soon as possible to be evaluated. The longer you wait, the more advanced your problems will probably become. There are several other medical conditions that can often be the cause of CTS instead of the usual mechanical offenders. That is why a thorough look over is needed from your doctor as he/she knows you best. True diagnosis of CTS involves several physical exam maneuvers, as well as, possible nerve conduction studies to verify nerve compression.

There are several options for treatment that can be discussed with your doctor. The method that will work best for you will depend on your particular situation and can range from a simple wrist brace to help prevent you from bending your wrist while you sleep, to the other end of the spectrum, which is surgery. Not all methods work for everyone. But hopefully one strategy or a combination of a few will work for you.

When in doubt, get that hand checked. And FINALLY get that excellent night of sleep you deserve!

So until next time....sleep tight....and Stay Healthy Hawaii!

GW