What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a condition of numbness and tingling in the hand and arm caused by compression of the mediannerve as it travels through the carpal tunnel. Causes include overuse of the wrist and hand, especially highly repetitive activities such as typing or working on an assembly line. Injuries can damage the carpal tunnel, as can arthritis, diabetes, and obesity.
Symptoms include numbness and shock-like pain in the wrist, palm, and fingers. There may be weakness in the hand when trying to hold an object. Carpal tunnel syndrome gets worse over time and may lead to permanent damage if not addressed.
Treatment options include supportive devices, stretching exercises, medications, and surgery.
Early diagnosis and treatment are important to prevent permanent nerve damage. Your doctor will diagnose carpal tunnel syndrome with a physical exam and special nerve tests. Treatment includes resting your hand, splints, pain and anti-inflammatory medicines. If symptoms do not improve with these less invasive treatments, your physician may recommend surgery.
How common is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is also known as
- Median nerve compression
Carpal Tunnel Syndrome Symptoms
Carpal tunnel syndrome is diagnosed via patient history and physical examination, X-rays, or electromyography testing.
It can be described by the following details experienced in the thumb, index, and middle fingers, and may even travel up to the shoulder. Nerve compression can cause several neurologic symptoms described by:
- Tingling: You may feel an odd sensation, sometimes described as "pins and needles" and occasionally accompanied by "electric shock" feelings.
- Numbness: You may feel like your hand has "fallen asleep."
- Weakness: Your hand and fingers may be weak, causing you to lose your grip or have difficulty grasping with your thumb.
- Transient, worsening, or persistent: Symptoms typically come and go throughout the day. They occur most with activities involving the wrist, such as holding a phone or driving but also can occur in the middle of the night, which is an important sign of carpal tunnel syndrome. Over time, symptoms often worsen and persist for longer periods.
Carpal Tunnel Syndrome Causes
The carpal tunnel is a roughly one-inch wide rigid passageway on the palm side of the wrist, formed by the wrist bones (carpals) and a tough band of tissue (the transverse ligament). It allows passage of the nine tendons that bend the fingers and thumb (flexor tendons) and the median nerve, which controls muscles and sensation around the thumb. Repetitive use of the hand and wrist may cause the inflammation leading to the nerve compression, impairing the passage of sensory and movement signals to and from the hand . Medical conditions can also predispose individuals to develop carpal tunnel.
People who use their hands repetitively may aggravate the wrist tendons, causing swelling. Activities that require bending the wrist can be especially aggravating. Some examples of repetitive hand activity include:
- Assembly line work: This may include manufacturing, cleaning, and packing.
- Using vibrating hand tools: This includes jackhammers or mixers.
- Long-distance cycling
- Holding a telephone
- Typing and computer use: This may be associated with carpal tunnel; however, it is debated.
Certain medical conditions increase the likelihood of developing symptoms of carpal tunnel syndrome, including:
- Rheumatoid Arthritis (RA): This is associated with swelling and inflammation around the tendons in the wrist.
- Wrist injuries: These can cause swelling.
- Pregnancy: Tissues throughout the body swell during pregnancy. Carpal tunnel syndrome that starts in pregnancy usually resolves after giving birth.
- Hypothyroidism: This can cause tissues to swell .
- Diabetes: This increases the risk of nerve damage, including damage to the median nerve.
- Obesity: This is associated with inflammation .
- Kidney failure: This can cause tissue swelling (edema).
Who is most likely to be affected
People with a family history of carpal tunnel syndrome may be predisposed to the condition through the anatomic composition of the wrist . Women are more affected than men, possibly due to smaller carpal tunnels .
Treatment Options and Prevention for Carpal Tunnel Syndrome
Treatment for carpal tunnel will likely depend on the severity of your symptoms. This may include a variety of non-surgical and surgical treatments. There are also several preventative measures that may be helpful for dealing with early symptoms.
Non-surgical treatments for carpal tunnel may include the following.
- Wrist splinting: This involves a hard, removable splint to stabilize your wrist in a straight position while you sleep. This can reduce pressure on the median nerve and prevent symptoms. Splinting has been found to be very effective in reducing symptoms of mild to moderate carpal tunnel syndrome .
- Nerve gliding exercises: Your physician or your physical or occupational therapist may recommend exercises to help the median nerve glide freely in the tunnel. These probably have only modest benefit but are easy to learn and try at home .
- Non-steroidal anti-inflammatory drugs (NSAIDs): Over-the-counter medications such as ibuprofen (Motrin, Advil) and naproxen (Aleve) can temporarily relieve pain from carpal tunnel syndrome but are not meant to be a long-term therapy.
- Corticosteroid injections: Your physician can inject a strong anti-inflammatory medicine into the tunnel. While these injections can effectively reduce symptoms, symptoms often return a couple months later. Oral steroids can also help reduce inflammation but have been found less effective than steroid injections.
- Alternative methods: Yoga has been found to reduce pain and improve strength when practiced by people with carpal tunnel syndrome . Acupuncture may also help relieve symptoms in some cases.
If your symptoms become severe and persistent, your physician may recommend surgery to prevent irreversible damage to your nerves and muscles. Carpal tunnel release surgery is one of the most common surgical procedures done in the United States. Outcomes are favorable in 70 to 90 percent of people who undergo the surgery .
Details: Carpal tunnel release surgery can be done under local or regional anesthesia and typically does not necessitate an overnight hospital stay. The procedure can be done endoscopically, with a couple of small incisions and a camera, or open, with a larger incision. Endoscopic surgery typically has a quicker recovery (with a return to work approximately eight days earlier than after open surgery), but also raises the likelihood of needing repeat procedures.
Prognosis: Wrist soreness can persist for several weeks or months after the surgery. Some residual numbness and weakness are common following the surgery; grip strength is typically regained within several months. If you experience persistent pain or weakness after the procedure, your surgeon may recommend hand therapy to help facilitate recovery.
Certain techniques and habits can minimize your chance of developing carpal tunnel.
- Take breaks when using your wrists: If you frequently work with your hands, take breaks to stretch your hands and wrists and alternate hand positions and activities. Shaking the hands often helps to relieve symptoms.
- Keep your hands warm: Hand pain and stiffness become worse in cold environments. Try to work in warmer environments or wear clothes or gloves that keep your wrists warm.
- Try to keep your wrists straight: Position your keyboard at elbow level or below to avoid bending your wrists excessively upward or downward.
- Try to minimize tension in your grip: Avoid holding objects with your hands more tightly than necessary.
When to Seek Further Consultation for Carpal Tunnel Syndrome
If your symptoms interfere with work, daily activities, or sleep, contact your physician about treatment options.
If your symptoms worsen or persist
If your symptoms are getting worse and leading to weakness, or your pain is becoming more persistent, speak with your physician about treatment options. Carpal tunnel syndrome can result in severe, irreversible nerve and muscle damage over time if not treated.
Questions Your Doctor May Ask to Determine Carpal Tunnel Syndrome
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Are you currently employed?
- How would you explain the cause of your shoulder pain?
- Can you fully move your shoulders around?
- How severe is your shoulder pain?
- How long has your shoulder pain been going on?
The above questions are also covered by our A.I. Health Assistant.
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