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Carpal tunnel syndrome
Definition
Carpal tunnel syndrome is a condition in which there is pressure on the median nerve -- the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.
Alternative Names
Median nerve dysfunction; Median nerve entrapment
Causes
The median nerve provides feeling and movement to the "thumb side" of the hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger).
The area in your wrist where the nerve enters the hand is called the carpal tunnel. This tunnel is normally narrow, so any swelling can pinch the nerve and cause pain, numbness, tingling or weakness. This is called carpal tunnel syndrome.
Some people who develop this problem were born with a carpal tunnel that is small.
Many people believe that carpal tunnel syndrome is caused by making the same hand and wrist motion over and over. In fact, using hand tools that vibrate may lead to carpal tunnel.
Yet, there are no good studies that prove carpal tunnel is caused by typing on a computer, using a mouse, or repeating movements while working, playing an instrument, or playing sports.
Carpal tunnel syndrome occurs most often in people 30 to 60 years old, and is more common in women than men.
Other factors that may lead to carpal tunnel syndrome include:
- Alcohol abuse
- Bone fractures and arthritis of the wrist
- Cyst or tumor that grows in the wrist
- Infections
- Obesity
- If your body keeps extra fluids during pregnancy or menopause
- Rheumatoid arthritis
Symptoms
- Clumsiness of the hand when gripping objects
- Numbness or tingling in the thumb and next two or three fingers of one or both hands
- Numbness or tingling of the palm of the hand
- Pain extending to the elbow
- Pain in the wrist or hand in one or both hands
- Problems with fine finger movements (coordination) in one or both hands
- Wasting away of the muscle under the thumb (in advanced or long-term cases)
- Weak grip or difficulty carrying bags (a common complaint)
- Weakness in one or both hands
Exams and Tests
During a physical examination, the health care provider may find:
- Numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger
- Weak hand grip
- Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand (this is called Tinel's sign)
- Bending the wrist forward all the way for 60 seconds will usually result in numbness, tingling, or weakness (this is called Phalen's test)
Tests may include:
- Electromyography
- Nerve conduction velocity
- Wrist x-rays should be done to rule out other problems (such as wrist arthritis)
Treatment
You may try wearing a splint at night for several weeks. If this does not help, you may need to try wearing the splint during the day. Avoid sleeping on your wrists. Hot and cold compresses may also be recommended.
There are many changes you can make in the workplace to reduce the stress on your wrist:
- Special devices include keyboards, different types of computer mouse, cushioned mouse pads, and keyboard drawers.
- Someone should review the position you are in when performing your work activities. For example, make sure the keyboard is low enough so that your wrists aren't bent upward while typing. Your health care provider may suggest an occupational therapist.
- You may also need to make changes in your work duties or recreational activities. Some of the jobs associated with carpal tunnel syndrome include those that involve typing and vibrating tools. Carpal tunnel syndrome has also been linked to professional musicians.
MEDICATIONS
Medications used in the treatment of carpal tunnel syndrome include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Corticosteroid injections, given into the carpal tunnel area, may relieve symptoms for a period of time.
SURGERY
Carpal tunnel release is a surgical procedure that cuts into the ligament that is pressing on the nerve. Surgery is successful most of the time, but it depends on how long the nerve compression has been occurring and its severity.
See also: Carpal tunnel release
Outlook (Prognosis)
Symptoms often improve with treatment, but more than 50% of cases eventually require surgery. Surgery is often successful, but full healing can take months.
Possible Complications
If the condition is treated properly, there are usually no complications. If untreated, the nerve can be damaged, causing permanent weakness, numbness, and tingling.
When to Contact a Medical Professional
Call for an appointment with your health care provider if:
- You have symptoms of carpal tunnel syndrome
- Your symptoms do not respond to regular treatment, such as rest and anti-inflammatory medications, or if there seems to be a loss of muscle in your fingers
Prevention
Avoid or reduce the number of repetitive wrist movements whenever possible. Use tools and equipment that are properly designed to reduce the risk of wrist injury.
Ergonomic aids, such as split keyboards, keyboard trays, typing pads, and wrist braces, may be used to improve wrist posture during typing. Take frequent breaks when typing and always stop if there is tingling or pain.
References
Huisstede Bm, Hoogvliet P, Randsdorp MS, Glerum S, van Middlekoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments -- a systematic review. Arch Phys Med Rehabil. 2010;91:981-1004.
Huisstede BM, Randsdorp MS, Coert Jh, Glerum S, van Middlekoop M, Koes BW. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments -- a systematic review. Arch Phys Med Rehabil. 2010;91:1005-1024.
Keith MW. American Academy of Orthopaedic Surgeons clinical practice guidelines on the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2009;91(10):2478-2479.
Keith MW. American Academy of Orthopaedic Surgeons clinical practice guidelines on the treatment of carpal tunnel syndrome. J Bone Joint Surg Am. 2010;92(1):218-219.
Thomsen JF, Gerr F, Atroshi I. Carpal tunnel syndrome and the use of computer mouse and keyboard: a systematic review. BMC Musculoskelet Disord. 2008 Oct6;9:134
Reviewed By: A.D.A.M. Health Solutions, Ebix, Inc. Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang. Previously reviewed by Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery (6/29/2012).
