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Patient education: Carpal tunnel syndrome (The Basics)

Patient education: Carpal tunnel syndrome (The Basics)

What is carpal tunnel syndrome? — Carpal tunnel syndrome is a condition that causes pain, numbness, and sometimes weakness in the fingers and hands. It happens when a nerve in the wrist called the "median nerve" gets pinched or squeezed.

The median nerve goes through a tunnel in the wrist. This tunnel is formed by the bones of the wrist and a tough band of tissue called a "ligament" (figure 1). Experts do not know exactly how the nerve can get pinched. But they think that it might happen when:

Tendons that go through the same tunnel get swollen (tendons are bands of tissue that connect muscles to bones).

Tissues surrounding the tendons harden or get swollen.

People use their hands for work that involves repetitive or forceful movements.

The median nerve carries signals about sensation from the hand to the brain. Then, it sends signals from the brain to the muscles. So it helps tell the brain what the hand is feeling and makes the muscles of the hand move. The nerve is connected to these parts of the hand:

Thumb

Index finger

Middle finger

Parts of the ring finger

Parts of the palm closest to the thumb

Females are more likely than males to get carpal tunnel syndrome. Being overweight probably increases the risk of carpal tunnel syndrome. Certain health conditions also might increase the risk, including diabetes and rheumatoid arthritis. Pregnant people are also more likely to get carpal tunnel syndrome, but it usually goes away after the baby is born.

What are the symptoms of carpal tunnel syndrome? — Symptoms include pain and tingling in the thumb and the index, middle, and ring fingers (figure 1). Symptoms are typically worst at night and can wake you up from sleep. Often, the symptoms affect both hands, but 1 hand might have worse symptoms than the other.

In some cases, the muscles of the hand, thumb, or fingers can be weak or feel clumsy. In other cases, pain and tingling can extend to the whole hand or even up to the wrist and forearm. Rarely, pain and tingling extends past the elbow to the shoulder.

The symptoms can also flare up when you do things that involve bending and unbending your wrist or raising your arms. Some activities can trigger symptoms in people with carpal tunnel syndrome. But they do not actually cause the condition. Examples include:

Driving

Reading

Typing

Holding a phone

Sleeping in certain positions

In many people, symptoms come and go. But some people eventually have symptoms all of the time. They can end up having trouble moving their fingers or controlling their grip.

Is there a test for carpal tunnel syndrome? — Yes. Electrical tests of the nerves can show if you have carpal tunnel syndrome, but these tests are not always necessary.

Your doctor will probably be able to tell if you have carpal tunnel syndrome by learning about your symptoms and doing an exam. During the exam, they might tap on or press on your wrist, or ask you to hold your hands in ways that are known to make symptoms worse.

But your doctor might order electrical nerve tests. These tests can confirm that you have carpal tunnel syndrome. They include:

Nerve conduction studies – Nerve conduction studies can show whether the median nerve is carrying electrical signals the right way. In people with carpal tunnel syndrome, signals can be slow or weak.

Electromyography ("EMG") – EMG can show whether the muscles in the hand and wrist are responding the right way to electrical signals. This test is most useful in figuring out if symptoms are related to carpal tunnel syndrome or another problem.

Should I see a doctor or nurse? — Yes. See your doctor or nurse if you have the symptoms described above, and they bother you.

How is carpal tunnel syndrome treated? — Treatments are often combined and can include:

Wrist splints – Some people feel better if they wear splints that keep their hands in a "neutral position." The neutral position is when the wrist is not bent forward or backward and the fingers are curled naturally toward the palm. Many people wear the splints only at night, but some people wear them during the day, too.

Doctors often suggest splints for people who get carpal tunnel syndrome during pregnancy. They usually don't need other treatments, since in most cases, symptoms improve after the baby is born.

Steroid shots or pills – Steroids are a group of medicines that control inflammation and swelling. To treat carpal tunnel syndrome, doctors sometimes inject steroids into the carpal tunnel. People who do not want to get a shot can take steroids as pills instead. But the pills are less effective than the shot.

Other physical treatments – Some people find that yoga helps with their symptoms. There is also weak evidence that something called "ultrasound therapy" might help in some cases. This involves using sound waves to try to treat symptoms. Other treatments such as "nerve gliding" and "carpal bone mobilization" are also sometimes helpful. These treatments are done by a physical or occupational therapist and involve moving the bones in your wrist around in a special way.

Surgery – Doctors offer surgery to people who have ongoing or severe nerve damage that is causing the symptoms of carpal tunnel syndrome. Surgery for carpal tunnel syndrome involves cutting the ligament that stretches across the wrist to form the tunnel.

Can carpal tunnel syndrome be prevented? — It's unclear whether there is any way to prevent carpal tunnel syndrome. People sometimes think that the condition happens because they use a computer too much. But studies have shown that computer use is probably not related to carpal tunnel syndrome.

More on this topic

Patient education: Hand pain (The Basics)
Patient education: Pregnancy symptoms (The Basics)
Patient education: Carpal tunnel surgery (The Basics)

This topic retrieved from UpToDate on: Feb 02, 2024.
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