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Pressure on
the median nerve causes carpal tunnel syndrome. This pressure can come from
swelling or anything that makes the carpal tunnel smaller. Many things can cause this swelling, including:
Making
the same hand movements over and over, especially if the wrist is bent down
(your hands lower than your wrists), or making the same wrist movements over
and over.
Pregnancy.
What are the symptoms?
Carpal tunnel syndrome can
cause tingling, numbness, weakness, or pain in the fingers or hand. Some people
may have pain in their arm between their hand and their elbow.
Symptoms most often occur in the thumb, index finger, middle finger, and
half of the ring finger. If you have problems with your other fingers but your
little finger is fine, this may be a sign that you have carpal tunnel syndrome.
A different nerve gives feeling to the little finger.
You may
first notice symptoms at night. You may be able to get relief by shaking your
hand.
How is carpal tunnel syndrome diagnosed?
Your doctor will ask if you have any
health problems-such as arthritis, hypothyroidism, or diabetes-or if you are
pregnant. He or she will ask if you recently hurt your wrist, arm, or neck.
Your doctor will want to know about your daily routine and any recent
activities that could have hurt your wrist.
During the exam, your
doctor will check the feeling, strength, and appearance of your neck,
shoulders, arms, wrists, and hands. Your doctor may suggest
tests, such as blood tests or nerve tests.
How is it treated?
Mild symptoms usually can be
treated with home care. You can:
Stop activities that cause numbness and pain.
Rest your wrist longer between activities.
Ice your wrist for 10 to
15 minutes 1 or 2 times an hour.
Wear a wrist splint at night. This takes pressure off your median
nerve.
The sooner you start treatment, the better your chances
of stopping symptoms and preventing long-term damage to the nerve.
You also
may need medicine for carpal tunnel syndrome or for a health problem that made
you likely to get carpal tunnel syndrome.
Surgery is an option.
But it's usually used only when symptoms are so bad that you can't work or do
other things even after several weeks to months of other treatment.
How can you keep carpal tunnel syndrome from coming back?
To keep carpal tunnel syndrome from coming back, take care of
your basic health. Stay at a healthy weight. Don't smoke. Exercise to stay
strong and flexible. If you have a long-term health problem, such as arthritis
or diabetes, follow your doctor's advice for keeping your condition under
control.
You can also try to take good care of your wrists and
hands:
Try to keep your wrist in a neutral
position.
Use your whole hand-not just your fingers-to hold
objects.
When you type, keep your wrists straight, with your hands
a little higher than your wrists. Relax your shoulders when your arms are at
your sides.
If you can, switch hands often when you repeat
movements.
Carpal tunnel syndrome occurs when a combination of health conditions and activities
puts pressure on the
median nerve as it passes through the
carpal tunnel in your wrist. This pressure leads to
symptoms. Anything that decreases the amount of space in the carpal
tunnel, increases the amount of tissue in the tunnel, or increases the
sensitivity of the median nerve can lead to carpal tunnel syndrome.
Things that help cause carpal tunnel syndrome include:
Conditions or illnesses that can cause or
contribute to arm pain or swelling in the joints and soft tissues in the arm,
or to reduced blood flow to the hands. These include
obesity,
rheumatoid arthritis,
gout,
diabetes,
lupus, and
hypothyroidism.
Broken wrist bones, dislocated bones, new
bone growth from healing bones, or bone spurs. These can take up space in the
carpal tunnel and put more pressure on the median nerve.
Carpal tunnel syndrome is a common work-related condition.
It can be caused by work that requires:
Forceful or repetitive hand movements.
Hand-arm vibration.
Working for long periods in the same or awkward positions.
Carpal tunnel syndrome is even more likely if you have these work-related issues along with other health conditions.
In some cases the cause of carpal tunnel
syndrome cannot be found.
Symptoms
Mild carpal tunnel symptoms most often affect the hand and
sometimes the forearm, but they can spread up to the shoulder. Symptoms
include:
Numbness or pain in your hand, forearm, or
wrist that awakens you at night. (Shaking or moving your fingers may ease this
numbness and pain.)
Occasional tingling, numbness,
"pins-and-needles" sensation, or pain. The feeling is similar to your hand
"falling asleep."
Numbness or pain that gets worse while you are
using your hand or wrist. You are most likely to feel it when you grip an object with your hand or
bend (flex) your wrist.
Occasional aching pain in your
forearm between your elbow and wrist.
Stiffness in your fingers when you get up in the morning.
With moderate or severe carpal tunnel symptoms, you may
have numbness or reduced strength and grip in your fingers, thumb, or hand. It
may be hard to:
Do simple hand movements, such as brushing your
hair or holding a fork. You may accidentally drop objects.
Pinch an
object between your thumb and first finger. (This is called loss of pinch
strength.)
Use your thumb while doing simple tasks such as opening
a jar or using a screwdriver. With long-term carpal tunnel syndrome, the
thumb muscles can get smaller and weaker (atrophy).
Symptoms
most often occur in parts of the hand supplied by the
median nerve: the thumb, the index finger, the middle finger,
and half of the ring finger. The median nerve doesn't affect your little finger. So if your little finger is affected, you may not have carpal tunnel syndrome.
Symptoms often occur in both hands, but they are usually worse in one hand
than the other. You may first notice symptoms at night. People with carpal
tunnel syndrome can usually fall asleep, but pain or numbness may wake them up.
Not all pain in the wrist or hand is caused by carpal
tunnel syndrome. There are many
other conditions with similar symptoms, such as:
The symptoms of
carpal tunnel syndrome usually develop gradually.
Symptoms often improve if you stop or change an activity that is
helping to cause the condition.
Most mild
cases of carpal tunnel syndrome get better with treatment. Usually there is no
permanent damage to the
median nerve. Your symptoms may improve by themselves
when:
Fluid buildup decreases, such as after
pregnancy.
You change or stop the activity that has caused your
carpal tunnel syndrome.
Other health problems that cause or
contribute to your carpal tunnel symptoms improve.
Long-term carpal tunnel syndrome can cause:
A loss of feeling and coordination in the
fingers and hand. The thumb muscles can become weak and waste away (atrophy).This can make it hard to grip or hold objects.
Permanent damage to
the median nerve. You may have trouble using the hand.
Carpal
tunnel syndrome is one of the most common causes of absence from
work.
What Increases Your Risk
Things that put you at risk for
carpal tunnel syndrome include:
Being female.
Women between the ages of 40 and 60 have the highest risk. Pregnant women near
the end of their pregnancies often have short-term symptoms. Women taking birth control pills, going through menopause, or taking
estrogen are also thought to be at risk.
Smoking. It may contribute to carpal tunnel syndrome by
affecting the blood flow to the median nerve.
Broken wrist bones, dislocated bones, new
bone growth from healing bones, or bone spurs. These can take up space in the
carpal tunnel and put more pressure on the median nerve.
Tumors and
other growths (such as
ganglions). These uncommon causes of carpal tunnel
syndrome are usually benign.
Normal wear and tear of the tissues in the hand and wrist caused
by aging.
When To Call a Doctor
Call 911 or go to an emergency room immediately if you notice sudden loss of feeling in your
arm.
Call your doctor if you:
Have tingling, numbness, weakness, or pain in
your fingers or hand that keeps coming back or that has not gone away after 2
weeks of home treatment.
Have gradually developed little or no
feeling in your fingers or hand.
Cannot do simple hand movements,
or you accidentally drop things.
Cannot pinch your thumb and index
finger together, or your pinch is weak.
Cannot use your thumb
normally (diminished thumb strength).
Have problems at work because
of pain in your fingers or hand.
Watchful waiting
You can treat mild symptoms of wrist and hand
pain or numbness at home. You may try home treatment for 1 to 2 weeks before
calling your doctor.
Who to see
To check your symptoms, you may first want to
consult the doctor who provides care for your other health conditions,
especially conditions that may be contributing to
carpal tunnel syndrome. (Health conditions such as
rheumatoid arthritis, hypothyroidism, or diabetes can all lead to carpal tunnel
syndrome.) Or, you may choose to see:
Carpal tunnel syndrome is usually diagnosed using:
Medical history. The doctor will ask about any medical problems
or illnesses, prior injuries, current symptoms, or daily activities that may be
causing your symptoms.
Hand diagram. You may be asked to help fill
in a diagram of your hand to show where you have numbness, tingling, or
pain.
Physical exam , including comparing the strength of both hands.
More testing
If your symptoms are severe,
if nonsurgical treatment has not improved symptoms, or if your symptoms aren't
clearly caused by carpal tunnel syndrome, your doctor may recommend:
X-rays . These can check for bone problems
caused by past injury,
arthritis, recently broken or dislocated bones, or
tumors. X-rays aren't used to diagnose carpal tunnel syndrome. But they can be
helpful for finding signs of arthritis or an old or new wrist or neck
injury that may be adding to your symptoms.
Ultrasound, to look at the size of the median nerve.
It is inexpensive, comfortable, and quick. But its use for carpal tunnel
syndrome diagnosis is still unproven and fairly uncommon.
MRI. This imaging test can find swelling
of the median nerve, narrowing of the carpal tunnel, or problems with
circulation of blood through the carpal tunnel.
The goal of treatment for
carpal tunnel syndrome is to allow you to return to
your normal function and activities and to prevent nerve damage and loss of muscle strength in your fingers and hand.
Treatment options include:
Home treatment, such as changing or avoiding activities that may be causing symptoms and wearing a wrist splint .
Medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation. In some cases, oral corticosteroids or corticosteroid injections into the carpal tunnel may be considered.
Surgery. Surgery is sometimes recommended when other treatment hasn't helped, if you've had carpal tunnel syndrome for a long time, or if there is nerve damage or the risk of nerve damage.
Treatment for carpal tunnel syndrome is based on the
seriousness of the condition, whether there is any nerve damage, and whether
other treatment has helped. If your symptoms are
mild, 1 to 2 weeks of
home treatment are likely to relieve your symptoms.
Prevention
To help prevent carpal tunnel syndrome:
Take good care of your general health. This includes
staying at a healthy weight, not smoking, and getting regular exercise.
Stop any activity
that you think may be causing finger, hand, or wrist numbness or
pain.
Use
hand and wrist movements that spread the pressure and
motion evenly throughout your hand and wrist. For example, keep your wrists straight or only slightly bent. Avoid activities that bend or twist the wrists for long periods of time.
Switch hands and
change positions often when you are doing repeated motions. Take breaks, and
rest your hands.
Restrict your salt intake if you
tend to retain fluid.
Wear a
wrist splint when you
cannot control your wrist motion, such as while sleeping. A splint can keep your wrist in a neutral position-that is, not bent too far forward or back-and reduce the stress on your fingers, hand, or wrist.
If you feel that certain work activities are causing
finger, hand, or wrist numbness or pain, talk to your human resources
department. Ask about different ways of doing your job, changes in
your equipment, other job assignments, or the possibility of an ergonomics
evaluation of your work space and procedures. For more
information, see the topic
Office Ergonomics .
In daily routines at
home or while doing hobbies, think about changing activities in which you make
repeated finger, hand, or wrist movements. Train yourself to use other
positions or techniques that won't stress your hand or wrist.
Home Treatment
Home treatment for
carpal tunnel syndrome:
Can ease pain and prevent further or permanent
damage to your median nerve.
May completely relieve your symptoms
if you start treatment when symptoms first occur.
If you have mild symptoms, such as occasional tingling,
numbness, weakness, or pain in your fingers or hand, follow these steps to
reduce
inflammation:
Rest your fingers, hand, and wrist.
Stop activities that you think may be causing numbness
and pain. When your symptoms improve, resume the activity gradually. As you do, keep your wrists straight
or only slightly bent.
Ice your wrist for 10 to 15 minutes at a time, once or twice an hour.
Consider taking nonsteroidal anti-inflammatory drugs
(NSAIDs) to
relieve pain and reduce swelling . Studies
haven't shown NSAIDs to be effective for carpal tunnel syndrome, but they may help
relieve your symptoms. Be safe with medicines. Read and follow all instructions on the label.
Wear a
wrist splint at night to keep your wrist in a neutral
position and relieve pressure on your median nerve.
When your pain is gone, begin
exercises for flexibility and strength for your arm
and wrist. Learn the best positions and posture for hand and wrist
movements.
Medications
Medicine may relieve swelling,
inflammation, and pain in the wrist or hand related to carpal tunnel syndrome. Reducing
swelling in the wrist will relieve pressure on the
median nerve in the carpal tunnel and relieve your symptoms.
Medicine choices
Nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain
and inflammation and are available with or without a prescription. They work best if your tendon is inflamed. NSAIDS don't relieve pressure on the median nerve, but they may make you feel better.
Corticosteroids may be a
treatment option when NSAIDs don't effectively relieve pain and
inflammation. But these are powerful
anti-inflammatory medicines. They have side effects that should be considered.
Corticosteroids can be taken in pill form or injected into the wrist by a
doctor.
What to think about
Medicine should be used with
other measures (such as ice, rest, and splints) to reduce pain and
inflammation.
Corticosteroids:
Usually aren't used until nonsurgical
treatments (such as rest, ice, splints, or anti-inflammatory medicines) have
been tried for several weeks with no improvement.
Often provide
temporary relief (for several weeks or more). Injected corticosteroids usually
provide longer-lasting results than those taken by mouth (oral). But oral or
injected medicines rarely provide permanent relief from carpal tunnel
symptoms.
Surgery
Most people with
carpal tunnel syndrome are treated without surgery.
Surgery is considered only when:
Symptoms haven't improved after several weeks to months of nonsurgical treatment. This assumes that you are having
ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery
more urgent.
Severe symptoms restrict normal daily activities, such
as when:
There is a persistent loss of feeling or coordination in the fingers or
hand.
There is decreased strength in the thumb.
Sleep is severely disturbed by
pain.
There is damage to the
median nerve (shown by nerve test results and loss of
hand, thumb, or finger function) or a risk of damage to the nerve.
The most common surgery for relieving carpal tunnel
symptoms involves cutting the transverse carpal ligament to relieve pressure on
the median nerve in the wrist. Two approaches for this surgery are:
Open carpal tunnel release surgery . Open surgery requires a longer recovery
period and leaves a larger scar than endoscopic surgery. But there may be less chance of other complications.
Endoscopic carpal tunnel release surgery . Recovery is quicker
than with open surgery. The scars heal more quickly, are smaller, and tend
to be less painful at 3 months after surgery. But there
may be a slightly higher chance of needing another surgery later.
Some surgeons are now doing small- or mini-open
release surgery. This requires a smaller incision than standard open carpal
tunnel release surgery. It may reduce healing time and scarring. But it also
allows the surgeon to view the ligament directly during the surgery to minimize
danger to the nerve itself. This procedure may be promising. But there are few
studies comparing it to the open carpal tunnel or endoscopic procedures at this
time.
What to think about
Nerve tests (nerve conduction velocity
test and electromyogram) are often completed before surgery is done. Surgery
is more likely to be successful if the results from nerve testing point to
carpal tunnel syndrome.
Your decision about whether to use open or endoscopic
surgery depends on your doctor's experience with the procedures. Endoscopic
carpal tunnel surgery uses very technical equipment and is most successful when
the doctor has done the procedure many times.
After surgery, it is important to avoid any activities that
may have caused carpal tunnel syndrome. Or you can change the way you do them.
Other Treatment
Other treatments for
carpal tunnel syndrome include:
Retraining (learning new ways of doing things), and
ergonomic considerations (such as having your body in the correct posture and
position and using equipment that is right for your strength and ability).
Some people try complementary medicine to help with the symptoms of tingling, numbness, weakness, or pain felt in
the fingers or hand. There is not strong evidence that they help.footnote 1 Some of these treatments include:
Dietary supplements , such as vitamin B6 (pyridoxine). High doses of vitamin B6 can cause nerve
problems (neuropathy).
Talk with your doctor about any complementary health practice that you would like to try or are already using. Your doctor can help you manage your health better if he or she knows about all of your health practices.
American Academy of Orthopaedic Surgeons (2016). Management of carpal tunnel syndrome evidence-based clinical practice guideline. http://www.orthoguidelines.org/topic?id=1020. Accessed July 1, 2016.
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American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Carpal tunnel syndrome. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 436-440. Rosemont, IL: American Academy of Orthopaedic Surgeons.
Bednar MS, et al. (2014). Hand surgery. In HR Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 456-516. New York: McGraw-Hill.
Mercier LR (2008). The forearm, wrist, and hand. In Practical Orthopedics, 6th ed, pp. 105-141. Philadelphia: Mosby Elsevier.
National Institute of Neurological Disorders and Stroke (2015). Carpal tunnel syndrome fact sheet. National Institutes of Health. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm. Accessed October 14, 2015.
Palmer KT, et al. (2007). Carpal tunnel syndrome and its relation to occupation: A systematic literature review. Occupational Medicine, 57(1): 57-66.
Piazzini DB, et al. (2007). A systematic review of the conservative treatment of carpal tunnel syndrome. Clinical Rehabilitation, 21(4): 299-213.
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Credits
ByHealthwise Staff Primary Medical ReviewerKathleen Romito, MD - Family Medicine Adam Husney, MD - Family Medicine E. Gregory Thompson, MD - Internal Medicine Specialist Medical ReviewerHerbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery
American Academy of Orthopaedic Surgeons (2016). Management of carpal tunnel syndrome evidence-based clinical practice guideline. http://www.orthoguidelines.org/topic?id=1020. Accessed July 1, 2016.
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