Carpal tunnel syndrome is the compression of the median nerve, the nerve that passes through your wrist. The median nerve is located on the palm side of your hand (also called the carpal tunnel). It serves your thumb and first three fingers. Carpal tunnel syndrome can occur in one or both of your hands.
The compression in carpal tunnel syndrome results from swelling inside your wrist. It can cause numbness and tingling to the side of your hand near the thumb. Carpal tunnel syndrome is quite common, existing in up to 10 percent of the U.S. population.
The pain in the carpal tunnel is caused by excess pressure in your wrist, which leads to inflammation. The most common cause of this inflammation is often an underlying medical condition that causes swelling in the wrist or obstructed blood flow. Some of the most frequent conditions linked with carpal tunnel syndrome are:
- thyroid dysfunction
- fluid retention from pregnancy or menopause
- high blood pressure
- autoimmune disorders such as rheumatoid arthritis
Carpal tunnel syndrome can be made worse if the wrist is over-extended repeatedly. Repeated motions of your wrist contribute to swelling and compression of the medial nerve. Problems include:
- poor positioning of your wrists while using your keyboard or mouse
- prolonged exposure to vibrations from using hand tools or power tools
- any repeated movement that over-extends your wrist like playing the piano or typing
Because carpal tunnel syndrome is a result of your medial nerve being compressed, the symptoms are usually found along the nerve path. Your hand may “fall asleep” frequently and drop objects. Other symptoms:
- numbness, tingling, and pain in your thumb and first three fingers of your hand
- pain and burning that travels up your arm
- wrist pain at night that interferes with sleep
The diagnosis of carpal tunnel syndrome is made through a combination of your history, a physical examination and tests called nerve conduction studies.
Physical examination: includes a detailed evaluation of your hand, wrist, shoulder, and neck to check for any other causes of nerve pressure. Your wrists are examined for tenderness, swelling, and any deformities.
Nerve conduction studies: diagnostic tests that can measure the conduction speed of your nerve impulses. If the nerve impulse is slower than normal, you may have carpal tunnel syndrome.
Treatment of carpal tunnel syndrome depends on how severe your pain and symptoms are. In 2008, the Academy of Orthopaedic Surgeons released guidelines for the effective treatment of carpal tunnel. The recommendation was to try and manage carpal tunnel pain without surgery, if possible.
Non-surgical options include:
- avoiding positions that over-extend your wrist
- wrist splints that hold your hand in a neutral position, especially at night
- mild pain medication and medications to reduce inflammation
- treatment of any underlying conditions you may have such as diabetes or arthritis
- steroid injections into your carpal tunnel area to reduce inflammation
Surgery may be necessary if there is severe damage to your median nerve. Surgery for carpal tunnel syndrome involves cutting away bands of tissue in the wrist that place pressure on your nerve. Although this surgical option is considered a last resort, the outcome is often very good.
- Gender: Women are three times more likely to be diagnosed with carpal tunnel syndrome than men.
- Age: Carpal tunnel syndrome is most frequently diagnosed between the ages of 30 and 60.
- Disease: Certain conditions increase your risk for developing carpal tunnel including diabetes, high blood pressure, and arthritis.
- Lifestyle factors: Lifestyle factors that may increase the risk for carpal tunnel syndrome include smoking, high salt intake, sedentary lifestyle, and a high body mass index (BMI).
- Hands-on occupations: Jobs that involve repetitive wrist movement include manufacturing, assembly line work, keyboarding occupations, and construction work. People who are employed in these occupations may be at higher risk of developing carpal tunnel syndrome
You can prevent carpal tunnel syndrome by making lifestyle changes that reduce your risk factors for developing it.
Treating conditions such as diabetes, high blood pressure, and arthritis reduces your risk for developing carpal tunnel syndrome.
Paying careful attention to hand posture and avoiding activities that over-extend your wrist are also important strategies to reduce symptoms. Exercises done in physical therapy may also be recommended.
Treating your carpal tunnel early with physical therapy and lifestyle changes can lead to significant long-term improvement and eliminate symptoms.
If left untreated, however, carpal tunnel can lead to permanent nerve damage, disability, and loss of hand function.