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What is carpal tunnel syndrome?

Carpal tunnel syndrome is a painful disorder of the wrist and hand. The carpal tunnel is a narrow tunnel formed by the bones and other tissues of your wrist. This tunnel protects your median nerve. The median nerve helps you move your thumbs and the first 3 fingers on each hand.

Carpal tunnel syndrome occurs when other tissues in the carpal tunnel (such as ligaments and tendons) get swollen or inflamed. When they do, they press against the median nerve. That pressure can make part of your hand hurt or feel numb.

Carpal tunnel syndrome usually isn’t serious. With treatment, the pain will typically go away and you’ll have no lasting damage to your hand or wrist.

What are the symptoms of carpal tunnel syndrome?

The symptoms of carpal tunnel syndrome include the following:

• Numbness or tingling in your hand and fingers, especially the thumb, index, and middle fingers.
• Pain in your wrist, palm, or forearm. You may shake or rub your hand to get relief.
• More numbness or pain at night than during the day. It may be so bad that it wakes you up.
• Pain that increases when you use your hand or wrist more.
• Trouble gripping objects, such as a doorknob or the steering wheel of a car.
• Weakness in your thumb.

What causes carpal tunnel syndrome?

Doing the same hand movements over and over can lead to carpal tunnel syndrome. It’s most common in people whose jobs require pinching or gripping with the wrist held bent. People at risk include people who use computers, carpenters, grocery checkers, assembly-line workers, meat packers, musicians, and mechanics. Hobbies such as gardening, needlework, golfing, and canoeing can sometimes bring on the symptoms.

Women are more likely to develop carpal tunnel syndrome than men. It also tends to be hereditary. This means it runs in families.

Carpal tunnel syndrome may also be caused by an injury to the wrist, such as

a fracture. Or it may be caused by a disease such as diabetes, rheumatoid arthritis, or thyroid disease. Carpal tunnel syndrome is also common during the last few months of pregnancy.

How is carpal tunnel syndrome diagnosed?

Your doctor will probably ask you about your symptoms. He or she may examine you and ask you how you use your hands. Your doctor may also do these tests:

• Your doctor may tap the inside of your wrist. You may feel pain or a sensation that feels like an electric shock.
• Your doctor may ask you to bend your wrist down for 1 minute to see if this causes symptoms.

Your doctor may order a nerve conduction test or an electromyography (EMG) test. They use these tests to see whether the nerves and muscles in your arm and hand show the typical effects of carpal tunnel syndrome.

Can carpal tunnel syndrome be prevented or avoided?

You can take steps to prevent carpal tunnel syndrome. The following actions may help to prevent it:

• Lose weight if you’re overweight.
• Get treatment for any disease you have that may cause carpal tunnel syndrome.
• If you do the same tasks over and over with your hands, try not to bend, extend, or twist your hands for long periods of time.
• Don’t work with your arms too close or too far from your body.
• Don’t rest your wrists on hard surfaces for long periods of time.
• Switch hands during work tasks.
• Make sure the tools you use aren’t too big for your hands.
• Take regular breaks from repeated hand movements to give your hands and wrists time to rest.
• If you use a keyboard a lot, adjust the height of your chair so that your forearms are level with your keyboard, and you don’t have to flex your wrists to type.

Many products you can buy, such as wrist rests for a computer keyboard, are supposed to ease symptoms of carpal tunnel syndrome. No one has proven that these products really prevent wrist problems. Some people may have less pain and numbness after using these products, but other people may have increased pain and numbness.

Carpal tunnel syndrome treatment

If carpal tunnel syndrome is caused by a medical problem (such as rheumatoid arthritis), your doctor should treat that problem first. Your doctor may ask you to rest your wrist or change how you use your hand. He or she may also ask you to wear a splint on your wrist. The splint keeps your wrist from moving but lets your hand do most of what it normally does. A splint can help ease the pain of carpal tunnel syndrome, especially at night.

Putting ice on your wrist to reduce swelling, massaging the area, and doing stretching exercises may also help. An over-the-counter non-steroidal anti-inflammatory drug (NSAID) can relieve swelling and pain. These medicines include aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve). In more severe cases, your doctor might inject your wrist with a corticosteroid, which reduces inflammation and pain.

What if these treatments don’t help?

In some cases, surgery is needed to make the symptoms go away completely. The surgery involves cutting the ligament that may be pressing on your median nerve. You’ll usually get back the normal use of your wrist and hand within a few weeks to a few months after surgery.

Doing the hand, wrist, and finger exercises that your doctor tells you to do after surgery is very important. Without exercise, your wrist may get stiff, and you may lose some use of your hand.

Living with carpal tunnel syndrome

You may decide against having surgery for your carpal tunnel syndrome. If so, here are some things that may help relieve your symptoms.

• Prop up your arm with pillows when you lie down.
• Avoid overusing the affected hand.
• Find a new way to use your hand by using a different tool.
• Try to use the unaffected hand more often.
• Avoid holding your wrists in a downward bent position for long periods of time.

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