Carpal tunnel syndrome is a nerve disorder of the hand caused by compression of the median nerve. The median nerve gets squeezed inside a narrow passage in the wrist called the carpal tunnel. This nerve provides feeling to the thumb, index and middle fingers, and half the ring finger.
Carpal tunnel syndrome is created by pressure on the median nerve caused by the narrowing of the carpal tunnel. The narrowing can be caused by a variety of factors including:
Swelling of tissue in carpal tunnel due to injury or fluid changes in the body
Hereditary narrow carpal tunnel
Tumors (rare)
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Carpal tunnel syndrome causes symptoms in one or both hands or wrists.
Symptoms may include:
Tingling, burning, or numbness, especially in the thumb and index or middle fingers
Pain or numbness that worsens with:
Wrist, hand, or finger movement
Sleep (symptoms may wake you)
Hand stiffness or cramping that gets better after:
Shaking the hand
Waking up in the morning
Weakness or clumsiness of the hand
Loss of grip strength
Difficulty making a fist
Frequently dropping things
Pain that moves up the arm
Diagnosis
The doctor will ask about your symptoms and medical history, and examine your arms, wrists, and hands. The physical exam will include tests of strength, sensation, and signs of nerve irritation or damage.
Other tests may include:
Electrodiagnostic exam (includes nerve conduction, and is commonly known as “
EMG
”)
MRI
of the neck (cervical spine) is sometimes needed
It is important to correct whatever is causing the carpal tunnel syndrome. Sometimes making simple changes in your workplace or home may help relieve symptoms.
Treatment may also include:
Rest, Ice, Elevation, and Exercises
Rest the wrist by keeping it straight and decreasing activities that worsen pain
Gently apply ice packs to the area
Elevate the hand above the heart to reduce swelling
Do exercises as directed by your healthcare provider
A Wrist Splint
A splint will prevent extreme movements of the wrist. It's most effective when worn at night and can help avoid waking up with symptoms.
Medications
Pain relievers like aspirin or ibuprofen
Injection of cortisone into the carpal tunnel
Surgery
Surgery may be needed if symptoms are severe or continue after trying other treatments. The most common procedure is the
carpal tunnel release
.
Prevention
You may reduce your chances of getting carpal tunnel syndrome by taking these steps:
Minimize repetitive hand movements when possible.
Alternate between activities or tasks to reduce the strain on your body.
When using your wrists, keep them straight and let your arms and shoulders share the stress.
Use your whole hand or both hands to pick up an item.
Avoid holding an object the same way for a long time.
If you work in an office, adjust your desk, chair, and keyboard so you are in the best possible position:
Back straight
Feet flat on the floor or resting on a footrest
Knees level with or slightly lower than your hips
Shoulders in a neutral position, not forward or back
Elbows bent at a 90 degree angle
Forearms parallel to the floor and wrists straight
Take breaks at least once an hour to:
Rest or shake your hands
Massage the palms and backs of your hands
Get regular aerobic exercise such as walking or swimming
Cut down on caffeine and smoking, which may reduce blood flow to your hands
RESOURCES:
American Academy of Orthopedic Surgeons http://www.aaos.org
American Association of Neurological Surgeons http://www.neurosurgery.org/aans
CANADIAN RESOURCES:
Physical Therapy.ca www.physicaltherapy.ca
The Association for Repetitive Motion Syndromes (ARMS) http://www.certifiedpst.com/arms/index.html
References:
Bengtson KA, Brault JS. DeLisa et al:
Physical Medicine & Rehabilitation: Principles and Practice
. 4th ed. Philadelphia; Lippincott Williams & Wilkins; 2005. Ch. 36.
Burke D.
Frontera: Essentials of Physical Medicine and Rehabilitation
. 1st ed. Philadelphia; Hanley and Belfus; 2002. Ch. 34.
Carpal tunnel syndrome.
The Female Patient
. 1997 Aug. 21-30.
Carpal tunnel syndrome.
Postgraduate Medicine
. 1995 Sept. 216.
Carpal tunnel syndrome: causes and risk factors. Dynamed website. Available at:
http://dynamed102.ebscohost.com/Detail.aspx?id=113671
. Accessed January 24, 2008.
Carpal tunnel syndrome: how you can help your patient overcome the symptoms.
Consultant
. 1994 Feb.
Carpal tunnel syndrome: a practical review.
Am Fam Physician
. 1994 May 1.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
