Description

Carpal tunnel syndrome is one of the most common hand conditions. It is caused by pressure on the median nerve in the carpal tunnel of the wrist. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of the hand. When the median nerve is compressed, the symptoms can include numbness, tingling, and weakness in the fingers and thumb.

Anatomy of the wrist, health conditions and possibly repetitive hand motions can contribute to carpal tunnel syndrome.

The proper treatment usually relieves the tingling and numbness and restores the function of the hand.

Symptoms

The symptoms of carpal tunnel syndrome usually begin gradually and are:

  • Tingling and numbness.Tingling and numbness can occur in the fingers or hand. Usually the thumb, index, middle, and ring fingers of the hand are affected, but not the little finger. You may have a feeling like an electric shock in these fingers. These symptoms often occur while holding a steering wheel, phone or newspaper, or may wake you from your sleep. The sensation you can also travel from the wrist up the arm. Many people "shake out" their hands to try to relieve their symptoms. The numb feeling may become constant over time.
  • The weakness. People with carpal tunnel syndrome you may experience weakness in the hand-and-drop objects. This may be due to numbness or weakness of the hand with the thumb to pinch the muscles, which are also controlled by the median nerve.

Tingling and numbness. Tingling and numbness can occur in the fingers or hand. Usually the thumb, index, middle, and ring fingers of the hand are affected, but not the little finger. You may have a feeling like an electric shock in these fingers. These symptoms often occur while holding a steering wheel, phone or newspaper, or may wake you from your sleep.

The sensation you can also travel from the wrist up the arm.

Many people "shake out" their hands to try to relieve their symptoms. The numb feeling may become constant over time.

When to see a doctor

Consult your health care professional if you have symptoms of carpal tunnel syndrome that interfere with their normal activities and sleep patterns. Permanent nerve and muscle damage can occur without the need for treatment.

Causes

Carpal tunnel syndrome is caused by pressure on the median nerve.

The median nerve runs from your forearm through a passageway in the wrist to the hand, known as the carpal tunnel. The median nerve provides feeling to the palm side of the thumb and all the fingers except the little finger. This nerve also provides signals to move the muscles around the base of the thumb. This movement is known as the motor function.

Anything that compresses or irritates the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. A wrist fracture can reduce the carpal tunnel and irritate the nerve. This can also occur due to the swelling and inflammation caused by rheumatoid arthritis or other diseases.

Many times, there is no single cause of carpal tunnel syndrome. Or the cause may not be known. It may be that a combination of risk factors that contribute to the development of the condition.

Risk factors

Several factors have been linked with carpal tunnel syndrome. Although they may not directly cause the carpal tunnel syndrome, which may increase the risk of eye irritation or damage to the median nerve. These include:

  • Anatomical factors.A wrist fracture or dislocation can alter the space within the carpal tunnel. The arthritis, which causes changes in the small bones of the wrist can affect the carpal tunnel. These changes may put pressure on the median nerve. People who have smaller carpal tunnels may be more likely to have carpal tunnel syndrome.
  • The sex assigned at birth.Carpal tunnel syndrome is usually more common in women. This may be due to the carpal tunnel area is relatively smaller in women than in men. Or it may be due to the effect of hormones on the lining of the tendons in the carpal tunnel. Women who have carpal tunnel syndrome can also have smaller carpal tunnels than women who do not have the condition.
  • Nerve-damaging conditions. Some chronic diseases, such as diabetes, increase the risk of nerve damage, including damage to the median nerve.
  • Inflammatory conditions. Rheumatoid arthritis, gout, and other conditions that cause swelling, known as inflammation, can affect the lining around the tendons of the wrist. This can put pressure on the median nerve.
  • Drugs. Some studies have shown a link between carpal tunnel syndrome and anastrozole (Arimidex), a drug used to treat breast cancer.
  • Obesity. Obesity is a risk factor for carpal tunnel syndrome.
  • The body fluid of the changes. The fluid retention may increase the pressure within the carpal tunnel syndrome, irritation of the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome happens with pregnancy usually gets better on its own after pregnancy.
  • Other medical conditions. Certain conditions, such as thyroid disorders, kidney failure and lymphedema, can increase the chances of getting carpal tunnel syndrome.
  • Factors in the workplace.Working with vibrating tools or in an assembly line that requires repetitive movements that the bending of the wrist can create pressure on the median nerve. This work also can worsen existing damage to the nerves. The pressure on the nerve may be worse if you work in a cold environment. However, the scientific evidence is conflicting, and these factors have not been established as direct causes of carpal tunnel syndrome. Several studies have evaluated whether there is a link between computer use and carpal tunnel syndrome. Some evidence suggests that the use of the mouse, but not the use of a keyboard, may be related to carpal tunnel syndrome. There has not been enough high-quality and consistent evidence to support the widespread use of the computer as a risk factor for carpal tunnel syndrome. However, the use of the computer may cause a different form of pain in the hand.

Anatomical factors. A wrist fracture or dislocation can alter the space within the carpal tunnel. The arthritis, which causes changes in the small bones of the wrist can affect the carpal tunnel. These changes may put pressure on the median nerve.

People who have smaller carpal tunnels may be more likely to have carpal tunnel syndrome.

The sex assigned at birth. Carpal tunnel syndrome is usually more common in women. This may be due to the carpal tunnel area is relatively smaller in women than in men. Or it may be due to the effect of hormones on the lining of the tendons in the carpal tunnel.

Women who have carpal tunnel syndrome can also have smaller carpal tunnels than women who do not have the condition.

Factors in the workplace. Working with vibrating tools or in an assembly line that requires repetitive movements that the bending of the wrist can create pressure on the median nerve. This work also can worsen existing damage to the nerves. The pressure on the nerve may be worse if you work in a cold environment.

However, the scientific evidence is conflicting, and these factors have not been established as direct causes of carpal tunnel syndrome.

Several studies have evaluated whether there is a link between computer use and carpal tunnel syndrome. Some evidence suggests that the use of the mouse, but not the use of a keyboard, may be related to carpal tunnel syndrome. There has not been enough high-quality and consistent evidence to support the widespread use of the computer as a risk factor for carpal tunnel syndrome. However, the use of the computer may cause a different form of pain in the hand.

Prevention

There are No proven strategies to prevent carpal tunnel syndrome, but it can also reduce the stress on hands and wrists with these methods:

  • Reduce your force and relax your grip. If your work involves a cash register or the keyboard, for example, pressing the keys gently.
  • Short, frequent breaks. Gently stretch and fold the hands and wrists regularly. Alternate tasks when possible. This is especially important if you use equipment that vibrates or required to exercise a great amount of force. Taking a break for even a few minutes every hour can make a difference.
  • See your way. Do not bend your wrist all the way up or down when you use a keyboard. A relaxed middle position with the wrists parallel to the floor is the best. Keep your keyboard at elbow height or slightly lower.
  • Improve your posture. The wrong posture can occur when you adjust your body to the view of the screen of a computer instead of adjusting the screen height and the distance to a correct posture. The incorrect posture, roll the shoulders forward and shortens the muscles of the neck and shoulders, and compresses the nerves in the neck. This can cause pain in the neck and can also disturb the hands and the arms.
  • Change your computer mouse. Make sure that the mouse is comfortable to use and doesn't stress your wrist.
  • Keep your hands warm. You are more likely to develop hand pain and stiffness if you work in a cold environment. If you can't control the temperature at work, put on the gloves without fingers which keep your hands and wrists warm.

Diagnosis

To diagnose carpal tunnel syndrome, your health care professional will ask about your symptoms. You may also need one or more tests to find out if you have carpal tunnel syndrome:

  • The history of the symptoms.The pattern of symptoms is important in making a diagnosis. Carpal tunnel syndrome symptoms usually occur while holding a phone or a newspaper, or grab a steering wheel. They also tend to occur at night and may wake you from sleep. Or you may notice that the numbness when you wake up in the morning. But the median nerve doesn't provide sensation to your little finger. If you have symptoms in the finger, you may have a condition other than carpal tunnel syndrome.
  • Test físico.Su health professional to test the feeling in the fingers of the hands and the strength of the muscles of the hand. Flexion of the wrist, touching on the nerve, or simply pressing on the nerve can cause symptoms in many people.
  • X-ray. You may need an x-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture. However, X-rays are not helpful in making a diagnosis of carpal tunnel syndrome.
  • Ultrasound. An ultrasound of the wrist provides a picture of the tendons and nerves. This can help show if the nerve is compressed.
  • Electromyography. This test measures the tiny electrical discharges produced in muscles. During this test, a thin needle electrode is inserted into specific muscles to assess the electrical activity when the muscles contract and the rest. This test can identify the damage to the muscles controlled by the median nerve. The test also can rule out other conditions.
  • The nerve conduction study. In a variation of the electromyography, two electrodes are taped to the skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test can be used to diagnose the disease and rule out other conditions.

The history of the symptoms. The pattern of symptoms is important in making a diagnosis. Carpal tunnel syndrome symptoms usually occur while holding a phone or a newspaper, or grab a steering wheel. They also tend to occur at night and may wake you from sleep. Or you may notice that the numbness when you wake up in the morning.

But the median nerve doesn't provide sensation to your little finger. If you have symptoms in the finger, you may have a condition other than carpal tunnel syndrome.

Physical exam. Your health care professional tests of sensation in the fingers of the hands and the strength of the muscles of the hand.

Flexion of the wrist, touching on the nerve, or simply pressing on the nerve can cause symptoms in many people.

Treatment

Treat carpal tunnel syndrome as soon as possible after the onset of symptoms. In the early stages, the simple things that you can do for yourself may make symptoms go away. For example:

  • Take more frequent breaks to rest your hands.
  • Do not do activities that make the symptoms worse.
  • The use of cold compresses to reduce swelling.

Other treatment options include the placement of a wrist splint, medication and surgery. Splints and other conservative treatments are more likely to help you if you have had only mild to moderate symptoms that come and go in for less than 10 months.

If you have numbness in your hands, get treatment from a health care professional.

Non-surgical therapy

If the condition is diagnosed early, the non-surgical methods can help improve carpal tunnel syndrome, including:

  • The placement of a wrist splint. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Although only wear the splint at night, you can also help prevent daytime symptoms. The night the placement of a splint may be a good option if you're pregnant, because they don't involve the use of any medication to be effective.
  • Nonsteroidal anti-inflammatory drugs (Nsaids).Nsaids, such as ibuprofen (Advil, Motrin IB, others) may help relieve the pain of carpal tunnel syndrome in the short term. There is No evidence, however, that these medications improve the carpal tunnel syndrome.
  • The corticosteroides.Su health care professional may be able to inject the carpal tunnel syndrome with corticosteroids, such as cortisone to relieve the pain. Sometimes an ultrasound is used to guide the injections. Reduces inflammation and swelling, and relieve pressure on the median nerve. Oral corticosteroids are not as effective as corticosteroid injections for the treatment of carpal tunnel syndrome.

Nonsteroidal anti-inflammatory drugs (Nsaids). Nsaids , such as ibuprofen (Advil, Motrin IB, others) may help relieve the pain of carpal tunnel syndrome in the short term.

There is No evidence, however, that these medications improve the carpal tunnel syndrome.

Corticosteroids. Your health care professional may be able to inject the carpal tunnel syndrome with corticosteroids, such as cortisone to relieve the pain. Sometimes an ultrasound is used to guide the injections.

Reduces inflammation and swelling, and relieve pressure on the median nerve. Oral corticosteroids are not as effective as corticosteroid injections for the treatment of carpal tunnel syndrome.

If carpal tunnel syndrome is caused by rheumatoid arthritis or other inflammatory arthritis, then the treatment of arthritis may reduce the symptoms of carpal tunnel syndrome. However, this has not been proven by research.

Surgery

The surgery may be appropriate if symptoms are severe or do not respond to other treatments.

The goal of carpal tunnel surgery is to relieve the pressure by cutting the ligament pressing on the median nerve.

Three different techniques that are used in the surgery of the carpal tunnel:

  • The endoscopic surgery.A surgeon uses a telescope-like device with a small camera called an endoscope. This allows the surgeon to view the inside of the carpal tunnel. The surgeon will cut the ligament through one or two small incisions in the wrist or hand. Endoscopic surgery may cause less pain than open surgery in the first days or weeks after surgery.
  • The open surgery. The surgeon makes a cut, called an incision in the palm of the hand over the carpal tunnel and passes through the ligament to release the nerve.
  • Ultrasound-guided surgery. This surgery is similar to the endoscopic surgery, but the surgeon uses ultrasound to see the nerves, tendons, arteries and ligaments. Then, the surgeon cuts the ligament with either a small knife or with a twisted wire put on the wrist through a needle.

The endoscopic surgery. A surgeon uses a telescope-like device with a small camera called an endoscope. This allows the surgeon to view the inside of the carpal tunnel. The surgeon will cut the ligament through one or two small incisions in the wrist or hand.

Endoscopic surgery may cause less pain than open surgery in the first days or weeks after surgery.

Discuss the risks and benefits of each technique with your surgeon prior to surgery. Risks of the surgery can include:

  • Incomplete release of the ligaments.
  • Infections of the wound.
  • The formation of the scar.
  • Injuries to the nerves or blood vessels.

During the healing process after the surgery, the tissue of the ligament gradually grow back together, while allowing more space for the nerves. This internal healing process typically takes several months, but the skin heals within a couple of weeks.

Your surgeon will probably recommend that you use the hand after the ligament has healed. Slowly return to full use of the hand and do not use forceful movements of the hand or extreme wrist positions.

Pain or weakness can last from several weeks to a few months to resolve after surgery. If your symptoms are very severe, you may not completely go away after surgery.

Lifestyle and home remedies

These steps may provide temporary relief of the symptoms:

  • Short, frequent breaks from repetitive activities that involve the use of hands.
  • Lose weight if you are overweight or obese.
  • Rotate the wrists and stretch the palms of the hands and fingers.
  • Take a pain reliever such as acetaminophen (Tylenol, others), aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
  • Use a snug, not tight, wrist splint at night. You can buy these without a prescription at most drugstores or pharmacies.
  • Do not sleep on the hands.

If pain, numbness or weakness persists, consult your health care professional.

Alternative medicine

Alternative therapies into your treatment plan can help manage carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always consult with your healthcare professional before trying any complementary or alternative treatment.

  • Yoga. The Yoga postures designed for strengthening, stretching and balance of the upper part of the body and joints can help reduce pain and improve grip strength.
  • Therapy of the hand. Early research suggests that certain physical and occupational hand therapy techniques to reduce the symptoms of carpal tunnel syndrome.

Preparing for your appointment

Here's some information to help you prepare for your appointment, and what to expect from your health care professional.

What you can do

  • Take note of when your symptoms are at their worst. Does any activity seem to be getting worse, or not aware of them at a certain time of day?
  • Keep track of the things that I've tried to do that the symptoms are better.
  • Write down the medicines you have taken to control their symptoms.

What to expect from your doctor

Your health care professional may ask:

  • How long have you had the problem?
  • Came on suddenly or develop over time?
  • Is improving, getting worse or staying the same?
  • There are certain activities that seem to cause, make it worse or make it better?

What you can do in the meantime

There are some simple things you can do before seeing a health professional for the first time.

First of all, try to find out if any of the activities seem to make your symptoms worse. Change the way of doing things, or not do, if it is possible. For example, if the driving seems to be the cause of the symptoms, try to change the position of the hands on the steering wheel.

You can also try to use a wrist splint at night to see if that helps symptoms.

Symptoms and treatment of Carpal tunnel syndrome