Illness & Conditions - Health Conditions
Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
Carpal tunnel syndrome is numbness, tingling, weakness, and other problems in your hand because of pressure on the median nerve in your wrist.
The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel . The median nerve controls movement and feeling in your thumb and first three fingers (not your little finger).
What causes carpal tunnel syndrome?
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:
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:
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:
Frequently Asked Questions
Health Tools help you make wise health decisions or take action to improve your health.
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:
Carpal tunnel syndrome is a common work-related condition. It can be caused by work that requires:
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.
Mild carpal tunnel symptoms most often affect the hand and sometimes the forearm, but they can spread up to the shoulder. Symptoms include:
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:
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:
Long-term carpal tunnel syndrome can cause:
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:
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:
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:
For more testing, see:
For treatment, see:
For surgery, see:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Carpal tunnel syndrome is usually diagnosed using:
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:
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:
What to think about
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.
To help prevent carpal tunnel syndrome:
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 for carpal tunnel syndrome:
If you have mild symptoms, such as occasional tingling, numbness, weakness, or pain in your fingers or hand, follow these steps to reduce inflammation :
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.
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.
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 medium 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.
Most people with carpal tunnel syndrome are treated without surgery. Surgery is considered only when:
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:
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 treatments for carpal tunnel syndrome include:
Complementary and alternative treatments
Some people try complementary and alternative treatments 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. 1 Some of these treatments include
Other Places To Get Help
Last Revised: October 2, 2012
American Academy of Orthopaedic Surgeons (2008, reaffirmed 2011). Clinical Practice Guideline on the Treatment of Carpal Tunnel Syndrome. Available online: http://www.aaos.org/Research/guidelines/CTStreatmentguide.asp.
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