Carpal tunnel syndrome

Definition

Carpal tunnel syndrome is a condition in which there is excessive pressure on the median nerve. This is the nerve in the wrist that allows feeling and movement to parts of the hand. Carpal tunnel syndrome can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.

Alternative Names

Median nerve dysfunction; Median nerve entrapment

Causes

The median nerve provides feeling and movement to the thumb side of the hand, including the palm, thumb, index finger, middle finger, and thumb side of the ring finger.

The area in your wrist where the nerve enters the hand is called the carpal tunnel. This tunnel is normally narrow. Any swelling can pinch the nerve and cause pain, numbness, tingling or weakness. This is called carpal tunnel syndrome.

Some people who develop this problem were born with a carpal tunnel that is small.

Carpal tunnel syndrome may be caused by making the same hand and wrist motion over and over. Using hand tools that vibrate may also lead to carpal tunnel.

Studies have not proved that carpal tunnel is caused by typing on a computer, using a mouse, or repeating movements while working, playing a musical instrument, or playing sports. But these activities may cause tendinitis or bursitis.

Carpal tunnel syndrome occurs most often in people 30 to 60 years old. It is more common in women than men.

Other factors that may lead to carpal tunnel syndrome include:

Symptoms

Exams and Tests

During a physical exam, the health care provider may find:

Tests that may be ordered include:

Treatment

Your health care provider may suggest the following:

Changes you can make in the workplace to reduce the stress on your wrist include:

MEDICATIONS

Medications used in the treatment of carpal tunnel syndrome include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Corticosteroid injections, given into the carpal tunnel area, may relieve symptoms for a period of time.

SURGERY

Carpal tunnel release is a surgical procedure that cuts into the ligament that is pressing on the nerve. Surgery is successful most of the time, but it depends on how long the nerve compression has been occurring and its severity.

Outlook (Prognosis)

Symptoms often improve without surgery. But more than half of cases eventually require surgery. Surgery is often successful, but full healing can take months.

If the condition is treated properly, there are usually no complications. If untreated, the nerve can be damaged, causing permanent weakness, numbness, and tingling.

When to Contact a Medical Professional

Call for an appointment with your health care provider if:

Prevention

Use tools and equipment that are properly designed to reduce the risk of wrist injury.

Ergonomic aids, such as split keyboards, keyboard trays, typing pads, and wrist braces, may be used to improve wrist posture during typing. Take frequent breaks when typing and always stop if there is tingling or pain.

References

Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middlekoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments -- a systematic review. Arch Phys Med Rehabil. 2010;91:981-1004.

Huisstede BM, Randsdorp MS, Coert Jh, Glerum S, van Middlekoop M, Koes BW. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments -- a systematic review. Arch Phys Med Rehabil. 2010;91:1005-1024.

Keith MW. American Academy of Orthopaedic Surgeons clinical practice guidelines on the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2009;91(10):2478-2479.

Keith MW. American Academy of Orthopaedic Surgeons clinical practice guidelines on the treatment of carpal tunnel syndrome. J Bone Joint Surg Am. 2010;92(1):218-219. 

Thomsen JF, Gerr F, Atroshi I. Carpal tunnel syndrome and the use of computer mouse and keyboard: a systematic review. BMC Musculoskelet Disord. 2008 Oct6;9:134