Carpal Tunnel Syndrome

Definition

Carpal tunnel syndrome is a nerve disorder of the hand caused by compression of the median nerve. The median nerve gets squeezed inside a narrow passage in the wrist called the carpal tunnel. This nerve provides feeling to the thumb, index and middle fingers, and half the ring finger.

Carpal Tunnel Syndrome

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Causes

Carpal tunnel syndrome is created by pressure on the median nerve caused by the narrowing of the carpal tunnel. The narrowing can be caused by a variety of factors including:

  • Swelling of tissue in carpal tunnel due to injury or fluid changes in the body
  • Hereditary narrow carpal tunnel
  • Tumors (rare)

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • Sex: female
  • Advancing age
  • Obesity
  • Excessive alcohol consumption
  • Smoking
  • Activities with repetitive hand motions:
    • Certain sports
    • Sewing
    • Playing musical instruments
    • Typing
    • Assembly tasks
  • Water retention from:
    • Heart failure
    • Kidney problems
  • Wrist injury:
    • Burns
    • Broken bones
    • Compression or crush injuries
  • Arthritis
  • Diabetes
  • Raynaud's disease which impairs blood flow in the hands
  • Hormone-related conditions:
  • Medications:

Symptoms

Carpal tunnel syndrome causes symptoms in one or both hands or wrists. Symptoms may include:

  • Tingling, burning, or numbness, especially in the thumb and index or middle fingers
  • Pain or numbness that worsens with:
    • Wrist, hand, or finger movement
    • Sleep (symptoms may wake you)
  • Hand stiffness or cramping that gets better after:
    • Shaking the hand
    • Waking up in the morning
  • Weakness or clumsiness of the hand
    • Loss of grip strength
    • Difficulty making a fist
    • Frequently dropping things
  • Pain that moves up the arm

Diagnosis

The doctor will ask about your symptoms and medical history, and examine your arms, wrists, and hands. The physical exam will include tests of strength, sensation, and signs of nerve irritation or damage.

Other tests may include:

  • Electrodiagnostic exam (includes nerve conduction, and is commonly known as “ EMG ”)
  • MRI of the neck (cervical spine) is sometimes needed
  • X-ray

Treatment

It is important to correct whatever is causing the carpal tunnel syndrome. Sometimes making simple changes in your workplace or home may help relieve symptoms.

Treatment may also include:

Rest, Ice, Elevation, and Exercises

  • Rest the wrist by keeping it straight and decreasing activities that worsen pain
  • Gently apply ice packs to the area
  • Elevate the hand above the heart to reduce swelling
  • Do exercises as directed by your healthcare provider

A Wrist Splint

A splint will prevent extreme movements of the wrist. It's most effective when worn at night and can help avoid waking up with symptoms.

Medications

  • Pain relievers like aspirin or ibuprofen
  • Injection of cortisone into the carpal tunnel

Surgery

Surgery may be needed if symptoms are severe or continue after trying other treatments. The most common procedure is the carpal tunnel release .

Prevention

You may reduce your chances of getting carpal tunnel syndrome by taking these steps:

  • Minimize repetitive hand movements when possible.
  • Alternate between activities or tasks to reduce the strain on your body.
  • When using your wrists, keep them straight and let your arms and shoulders share the stress.
  • Use your whole hand or both hands to pick up an item.
  • Avoid holding an object the same way for a long time.
  • If you work in an office, adjust your desk, chair, and keyboard so you are in the best possible position:
    • Back straight
    • Feet flat on the floor or resting on a footrest
    • Knees level with or slightly lower than your hips
    • Shoulders in a neutral position, not forward or back
    • Elbows bent at a 90 degree angle
    • Forearms parallel to the floor and wrists straight
  • Take breaks at least once an hour to:
    • Rest or shake your hands
    • Massage the palms and backs of your hands
  • Get regular aerobic exercise such as walking or swimming
  • Cut down on caffeine and smoking, which may reduce blood flow to your hands

RESOURCES:

American Academy of Orthopedic Surgeons
http://www.aaos.org

American Association of Neurological Surgeons
http://www.neurosurgery.org/aans

CANADIAN RESOURCES:

Physical Therapy.ca
www.physicaltherapy.ca

The Association for Repetitive Motion Syndromes (ARMS)
http://www.certifiedpst.com/arms/index.html

References:

Bengtson KA, Brault JS. DeLisa et al: Physical Medicine & Rehabilitation: Principles and Practice . 4th ed. Philadelphia; Lippincott Williams & Wilkins; 2005. Ch. 36.

Burke D. Frontera: Essentials of Physical Medicine and Rehabilitation . 1st ed. Philadelphia; Hanley and Belfus; 2002. Ch. 34.

Carpal tunnel syndrome. The Female Patient . 1997 Aug. 21-30.

Carpal tunnel syndrome. Postgraduate Medicine . 1995 Sept. 216.

Carpal tunnel syndrome: causes and risk factors. Dynamed website. Available at: http://dynamed102.ebscohost.com/Detail.aspx?id=113671 . Accessed January 24, 2008.

Carpal tunnel syndrome: how you can help your patient overcome the symptoms. Consultant . 1994 Feb.

Carpal tunnel syndrome: a practical review. Am Fam Physician . 1994 May 1.

Practical management of carpal tunnel syndrome. Phys Sportsmed . 1995 Jan.

Understanding and managing carpal tunnel syndrome. Journal of Musculoskeletal Medicine . 1999 Nov.



Last reviewed January 2008 by John C. Keel, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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