Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a common, painful disorder of the wrist and hand.

How does it occur?

Carpal tunnel syndrome is caused by pressure on the median nerve in your wrist. People who use their hands and wrists repeatedly in the same way (for example, illustrators, carpenters, and assembly-line workers) tend to develop carpal tunnel syndrome.

Pressure on the nerve may also be caused by a fracture or other injury, which may cause inflammation and swelling. In addition, pressure may be caused by inflammation and swelling associated with arthritis, diabetes, and hypothyroidism. Carpal tunnel syndrome can also occur during pregnancy.

What are the symptoms?

The symptoms include:

• pain, numbness, or tingling in your hand and wrist, especially in the thumb and index and middle fingers; pain may radiate up into the forearm
• increased pain with increased use of your hand, such as when you are driving or reading the newspaper
• increased pain at night
• weak grip and tendency to drop objects held in the hand
• sensitivity to cold
• muscle deterioration especially in the thumb (in later stages)

How is it diagnosed?

Your healthcare provider will review your symptoms, examine you, and discuss the ways you use your hands. He or she may also do the following tests:

• Your provider may tap the inside middle of your wrist over the median nerve. You may feel pain or a sensation like an electric shock.
• You may be asked to bend your wrist down for one minute to see if this causes symptoms.
• Your provider may arrange to test the response of your nerves and muscles to electrical stimulation.

How is it treated?

If you have a disease that is causing carpal tunnel syndrome (such as rheumatoid arthritis), treatment of the disease may relieve your symptoms.

Other treatment focuses on relieving irritation and pressure on the nerve in your wrist. To relieve pressure your healthcare provider may suggest:

• restricting use of your hand or changing the way you use it
• changing your work station (the position of your desk, computer, and chair) to one that irritates your wrist less
• wearing a wrist splint
• exercises

Your provider may prescribe an oral cortisone-like medicine or a nonsteroidal anti-inflammatory medicine, such as ibuprofen. He or she may recommend an injection of a cortisone-like medicine into the carpal tunnel area. In some cases surgery may be necessary. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider's approval.

How long will the effects last?

How long the symptoms of carpal tunnel syndrome last depends on the cause and your response to treatment. Sometimes the symptoms disappear without any treatment, or they may be relieved by nonsurgical treatment. Surgery may be necessary to relieve the symptoms if they do not respond to treatment or they get worse. Surgery usually relieves the symptoms, especially if there is no permanent damage to the nerve.

Symptoms of carpal tunnel syndrome that occur during pregnancy usually disappear following delivery.

How can I take care of myself?

Follow your healthcare provider's recommendations. Also try the following:

• Elevate your arm with pillows when you lie down.
• Avoid activities that overuse your hand.
• When you use a computer mouse, use it with the hand that does not have carpal tunnel syndrome.
• Find a different way to use your hand by using another tool or try to use the other hand.
• Avoid bending your wrists.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activities will be determined by how soon your wrist recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may return to your activities when you are able to painlessly grip objects and have full range of motion and strength back in your wrist.

What can I do to help prevent carpal tunnel syndrome?

If you do very repetitive work with your hands, make sure that your hands and wrists are comfortable when you are using them. Take regular breaks from the repetitive motion. Avoid resting your wrists on hard or ridged surfaces for prolonged periods.

If you have a disease that is associated with carpal tunnel syndrome, effective treatment of the disease might help prevent this condition.

In some cases the cause is not known and carpal tunnel syndrome cannot be prevented.