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 in the same motion over and over tend to develop carpal tunnel syndrome. It is common in cashiers, carpenters, assembly-line workers, and people who work on the computer.

Swelling from a broken bone or other injury can cause pressure on the nerve as well. Diseases such as arthritis, diabetes, or hypothyroidism can cause swelling and pressure in the wrist. Sometimes it happens 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), treating 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 the position of your desk, computer, and chair to one that irritates your wrist less
• wearing a wrist splint
• exercises

Your provider may prescribe a steroid medicine or a nonsteroidal anti-inflammatory medicine, such as ibuprofen. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.

Your provider may give you an injection of a corticosteroid medicine.

In some cases surgery may be necessary.

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 go away without any treatment, or they may be relieved by nonsurgical treatment. Surgery may be needed 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:

• Raise your arm on a pillow when you sit or 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 depends on 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 is to return 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?

Make sure that your hands and wrists are supported, especially if you do repetitive work. Take regular breaks from the repetitive motion. Do not rest your wrists on hard or ridged surfaces for long periods of time.

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