Carpal Tunnel Syndrome: Topic Overview

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Topic Overview

What is carpal tunnel syndrome?

Carpal tunnel syndrome is pain, tingling, 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).

See a picture of the carpal tunnel .

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. Things that can lead to carpal tunnel syndrome include:

• Illnesses such as hypothyroidism, rheumatoid arthritis, and diabetes.
• Pregnancy.
• Obesity.
• Making the same hand movements over and over, especially if the wrist is bent down (your hands lower than your wrists), or making the same wrist movements over and over.
• Wrist injuries and bone spurs.
• Smoking, because it can reduce blood flow to the median nerve.

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 do a physical exam and ask about your health and activities. You also may have some tests.

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 to see if any health problems might be causing your symptoms.
• Nerve testing to find out if the median nerve is working as it should.

How is it treated?

Mild symptoms usually can be treated with home care. The sooner you start treatment, the better your chances of stopping symptoms and preventing long-term damage to the nerve.

You can do a few things at home to help your hand and wrist feel better:

• Stop activities that cause numbness and pain. Rest your wrist longer between activities.
• Ice your wrist for 10 to 15 minutes 1 or 2 times an hour. Try taking nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce swelling.
• Wear a wrist splint at night to keep your wrist in a neutral position. This takes pressure off your median nerve. Your wrist is in a neutral position when it is straight or only slightly bent. Holding a glass of water is an example of your wrist in a neutral position.

See your doctor if your symptoms do not get better after 1 to 2 weeks of home care, or if you have had bad symptoms from the start. You 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 3 to 12 months of other treatment.

During surgery, the doctor cuts the ligament at the top of the carpal tunnel. This makes more room in the tunnel and relieves pressure on the nerve. Surgery usually works to ease symptoms. But in some cases it does not completely get rid of numbness or pain.

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:

• Try to keep your wrist in a neutral position.
• Use your whole hand—not just your fingers—to hold objects.
• When you type, keep your wrists straight, with your hands a little higher than your wrists. Relax your shoulders when your arms are at your sides.
• If you can, switch hands often when you repeat movements.

Frequently Asked Questions

Last updated:	October 29, 2008
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	William M. Green, MD - Emergency Medicine, David Pichora, MD, FRCSC - Orthopedic Surgery
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC