The Matter at Hand

Prevent, treat carpal tunnel syndrome and de Quervain’s syndrome.

by Bradley Sandella, D.O.
Director of sports medicine, ChristianaCare

Whether you are working on the computer, picking up your 2-year-old or playing pickleball, you rely on the strength and flexibility of your wrists and fingers. Occasionally, you might feel pain or tingling. It’s all too easy to shake your wrists and keep going. But if this happens often, you may have carpal tunnel syndrome or de Quervain’s tenosynovitis.

Effective—and early—treatment can ease the symptoms of both. Left unchecked, however, these conditions can cause significant pain and, in some cases, permanent damage.

What is carpal tunnel syndrome?

The carpal tunnel in your wrist is formed by the small carpal bones and the transverse carpal ligament, a band of connective tissue. This tight passageway is a highway for the nine flexor tendons that bend the fingers and the median nerve, which supplies feeling to your thumb and first three fingers. The median nerve also controls the muscles at the thumb’s base.

Swelling in the carpal tunnel puts pressure on the median nerve. You may feel pain, tingling and numbness in the wrist, thumb and the first three fingers. (The little finger is usually unaffected.) You may also have a jolt of shock-like pain.

Diagram of the hand and how Carpal Tunnel Syndrome distributes pain.

What are the risk factors?

Risk factors include:

  • Age and sex. Many patients are between 30 and 60. Women are more likely to have carpal tunnel syndrome than men, especially during pregnancy, when hormonal changes cause swelling.
  • Heredity. Some people have a small carpal tunnel.
  • Jobs or activities that require repetitive motions and put pressure on the wrist.
  • Medical conditions, such as diabetes or rheumatoid arthritis.

When should I see a health care professional?

The sooner you can see your health care provider, the sooner you can reduce inflammation and pressure. Don’t wait until you’re repeatedly waking up with numb hands. Carpal tunnel syndrome can cause permanent damage.

What are the treatments?

Treatments, which depend on the severity of the condition, can include:

  • Gentle stretches.
  • Splinting, particularly at night or during repetitive activities, to keep the wrist neutral.
  • Nonsteroidal anti-inflammatory medications, such as ibuprofen, to reduce swelling.
  • Corticosteroid injections in the targeted area.
  • Out-patient surgery for moderate-to-severe carpal tunnel impingement.

What is De Quervain’s tenosynovitis?

De Quervain’s also involves a tunnel, only this passageway is located where your thumb meets your wrist. The two tendons in this tunnel move your thumb when you grasp, grip or make a fist. Swelling or thickening in the sheath puts pressure on the tendons, causing pain and restricting motion.

The cause of de Quervain’s is unknown. Most of the time, it’s related to overuse, such as enthusiastic gardening or regularly playing racket sports. New moms overuse their wrists when picking up young children, which is why some patients are in their 20s.

What is the treatment?

Resting the thumb, icing and nonsteroidal anti-inflammatory drugs can help. Other treatments include:

  • Splinting or braces.
  • Corticosteroid injections.
  • Physical therapy to strengthen the muscles and use your wrist properly.
  • Surgery, which releases the pressure, may be indicated for more severe cases.

After treatment, you must be vigilant: These conditions can return. Early detection is essential if you want to continue an active, pain-free lifestyle.

If you’re concerned that you may have symptoms, you should get in touch with a Sports Medicine Specialist as soon as possible.


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