Carpal Tunnel Syndrome

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Introduction

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a common disorder that is often associated with repetitive actions of the hands and wrists, such as typing at a keyboard. Carpal tunnel syndrome can lead to pain, numbness, and sometimes disability of the hands. It is a type of repetitive stress injury and a common occupational injury.

Carpal tunnel syndrome is the result of the compression of the median nerve, which runs through the wrist. The median nerve is located in a narrow channel in the wrist called the carpal tunnel, which is created by bones and a ligament.

The functions of the median nerve are to transmit sensations from the fingers and hands to the spinal cord and control movement of the hand and forearm muscles. The median nerve can be compressed when repetitive activities of the hand and wrist cause swelling and inflammation in the wrist and in the carpal tunnel. The way that this inflammation affects people can vary, but typical symptoms include burning and numbness in the hands.

Early diagnosis and treatment can reduce or eliminate symptoms and complications of carpal tunnel syndrome, such as permanent hand numbness and grip weakness. Seek prompt medical care if you have symptoms of carpal tunnel syndrome, such as burning and numbness in your hands,or pain in your hand, wrist or forearm.

Symptoms

What are the symptoms of carpal tunnel syndrome?

At the onset of carpal tunnel syndrome, symptoms are often vague and develop slowly, but the severity and nature of symptoms can vary between individuals. Symptoms may include:

  • Pain and other symptoms affecting the hand, arm or shoulder that are worse at night

  • Pain, burning, weakness, numbness or tingling of the fingers, hands, wrists, forearms, and up to the shoulder in some cases

Changing your position or shaking your hand may bring some amount of symptom relief.

Causes

What causes carpal tunnel syndrome?

Carpal tunnel syndrome is caused by compression of the median nerve, which runs through the wrist. Compression of the median nerve can be caused by fluid retention, swelling, or abnormal bone anatomy in the wrist. Specifically, median nerve compression can be caused by such conditions as:

  • Acromegaly (hormonal disorder that leads to bone and cartilage overgrowth)

  • Diabetes (chronic condition that affects your body’s ability to use sugar for energy)

  • Hand or wrist trauma or fracture

  • Hypothyroidism (underactive thyroid)

  • Menopause

  • Pregnancy

  • Repetitive or jarring motions of the hands and wrists due to such activities as typing, keyboarding, sewing, performing dental work, or using a chain saw or jackhammer

  • Rheumatoid arthritis (chronic autoimmune disease characterized by joint inflammation)

What are the risk factors for carpal tunnel syndrome?

A number of factors are thought to increase your chances of developing carpal tunnel syndrome. Risk factors for carpal tunnel syndrome include:

  • Acromegaly (hormonal disorder that leads to bone and cartilage overgrowth)

  • Diabetes (chronic condition that affects your body’s ability to use sugar for energy)

  • Family history of carpal tunnel syndrome

  • Hand or wrist trauma or fracture

  • Hypothyroidism (underactive thyroid)

  • Long-term repetitive or strenuous actions, or jarring of the hands and wrists, such as keyboarding, sewing, performing dental work, or using a chain saw or jackhammer

  • Menopause

  • Pregnancy

  • Rheumatoid arthritis (chronic autoimmune disease characterized by joint inflammation)

Reducing your risk of carpal tunnel syndrome

Not all people with risk factors will get carpal tunnel syndrome, but you can lower your risk of developing carpal tunnel syndrome by minimizing pressure on the median nerve. Measures you can take include:

  • Changing or limiting repetitive motion or jarring activities of the hands and wrists, such as keyboarding, sewing, performing dental work, or using power tools

  • Ensuring that keyboards are placed low enough so that wrists are not flexed

  • Not flexing the wrists for long periods of time

  • Seeking regular medical care and following your treatment plan for underlying conditions, such as acromegaly, diabetes, hypothyroidism, pregnancy, rheumatoid arthritis, and trauma to the hand or wrist

Treatments

How is carpal tunnel syndrome treated?

With early recognition and treatment, it is possible to reverse the symptoms of carpal tunnel syndrome before permanent nerve damage and complications occur. Treatment plans use a multifaceted approach aimed at relieving the compression of the median nerve. Treatment includes:

  • Acupressure and acupuncture, which may help reduce pressure on the median nerve

  • Anti-inflammatory medications including nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil and Motrin) and aspirin. NSAIDs are very effective in treating the pain and inflammation of carpal tunnel syndrome. However, long-term use of NSAIDs can cause serious, even life-threatening side effects and adverse events. These include bleeding gastrointestinal ulcers and possible heart problems and cardiovascular events. NSAIDs should only be taken as directed by your health care provider.

  • Changing or limiting repetitive motion or jarring activities of the hands and wrists, such as keyboarding, sewing, performing dental work, or using power tools

  • Corticosteroids to reduce the inflammation and pain of carpal tunnel syndrome. Corticosteroids are generally given through direct injection into the carpal tunnel of the wrist.

  • Following your treatment plan for underlying conditions, such as acromegaly, diabetes, hypothyroidism, pregnancy, rheumatoid arthritis, and trauma to the hand or wrist

  • Splinting of affected wrist at bedtime

  • Surgery to relieve pressure on the median nerve. This surgery, called carpal tunnel release, is generally recommended for people with demonstrated nerve conduction abnormalities who do not get relief with other measures.

What are the potential complications of carpal tunnel syndrome?

Advanced cases of carpal tunnel syndrome that are untreated can lead to complications due to ongoing compression on the median nerve that runs through the wrist. You can help minimize your risk of complications by following the treatment plan you and your health care professional design specifically for you. Complications of carpal tunnel syndrome include:

  • Atrophy of hand muscles and hand deformity

  • Disability of the hand

  • Permanent hand numbness

  • Permanent hand weakness

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 4
  1. Acromegaly. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. http://endocrine.niddk.nih.gov/pubs/acro/acro.htm
  2. Carpal Tunnel Syndrome. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00005
  3. Carpal Tunnel Syndrome. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000433.htm 
  4. Tierney LM Jr., Saint S, Whooley MA (Eds.) Current Essentials of Medicine (4th ed.). New York: McGraw-Hill, 2011.
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