Carpal Tunnel Syndrome
Carpal tunnel syndrome is a condition that causes numbness, tingling and other symptoms in the hand and arm. Carpal tunnel syndrome is caused by a compressed nerve in the carpal tunnel, a narrow passageway on the palm side of your wrist.
The anatomy of your wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome.
Proper treatment usually relieves the tingling and numbness and restores wrist and hand function. Many people get better if they rest their wrist and wear a splint. Some people need surgery.
Carpal tunnel syndrome symptoms usually start gradually. The first symptoms often include numbness or tingling in your thumb, index and middle fingers that comes and goes.
Carpal tunnel syndrome may also cause discomfort in your wrist and the palm of your hand. Common carpal tunnel syndrome symptoms include:
The sensation may travel from your wrist up your arm. These symptoms often occur while holding a steering wheel, phone or newspaper. The sensation may wake you from sleep.
Many people “shake out” their hands to try to relieve their symptoms. The numb feeling may become constant over time.
See your doctor if you have persistent signs and symptoms suggestive of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Permanent nerve and muscle damage can occur without treatment.
Carpal tunnel syndrome is caused by pressure on the median nerve.
The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).
Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis.
There is no single cause in many cases. It may be that a combination of risk factors contributes to the development of the condition.
A number of factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase your chances of developing or aggravating median nerve damage. These include:
People with smaller carpal tunnels may be more likely to have carpal tunnel syndrome.
Your doctor may ask you questions and conduct one or more of the following tests to determine whether you have carpal tunnel syndrome:
Carpal tunnel syndrome symptoms usually occur include while holding a phone or a newspaper, gripping a steering wheel, or waking up during the night.
Bending the wrist, tapping on the nerve or simply pressing on the nerve can trigger symptoms in many people.
However, the scientific evidence is conflicting and these factors haven’t been established as direct causes of carpal tunnel syndrome.
Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.
Treat carpal tunnel syndrome as early as possible after symptoms start.
Take more frequent breaks to rest your hands. Avoiding activities that worsen symptoms and applying cold packs to reduce swelling also may help.
Other treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help if you’ve had only mild to moderate symptoms for less than 10 months.
If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome, including:
There isn’t evidence, however, that these drugs improve carpal tunnel syndrome.
Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren’t considered as effective as corticosteroid injections for treating carpal tunnel syndrome.
If carpal tunnel syndrome is caused by rheumatoid arthritis or another inflammatory arthritis, then treating the arthritis may reduce symptoms of carpal tunnel syndrome. However, this is unproved.
Surgery may be appropriate if your symptoms are severe or don’t respond to other treatments.
The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.
The surgery may be performed with two different techniques:
Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.
Discuss the risks and benefits of each technique with your surgeon before surgery. Surgery risks may include:
During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve. This internal healing process typically takes several months, but the skin heals in a few weeks.
Integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your doctor before trying any complementary or alternative treatment.