What You Can Expect
At the onset of carpal tunnel syndrome, you might feel tingling in your first three fingers, especially at night. An intense,
burning pain and hand weakness indicates a more advanced case. If the symptoms are left untreated, you may lose practical
use of your hands through degeneration of the muscles at the base of the thumb. Additionally, there is the possibility of
permanent nerve damage, accompanied by loss of hand movement and sensation. Severe damage can be prevented if the early
symptoms are given medical attention.
Anti-inflammatory drugs may help symptoms recede, but this relief may only be temporary. Many cases require prolonged
activity-modification and use of a splint on the injured wrist and hand. Initially, the splint is worn mainly at night and during
work activity to reduce pressure on the median nerve generated by prolonged flexion and extension at the wrist.
If conservative measures fail to bring relief after six months, injections to reduce inflamation may be an option. After that,
surgery may be considered. A hand surgeon can reduce the compression of the median nerve by cutting into ligaments in the
wrist. Most remedial surgeries are successful, and the incision generally heals within two weeks. Two more weeks of
monitoring by your physician may be required to regain full strength of the hand and occupational therapists are also helpful
in the rehabilitation process.
Established Causes
Carpal tunnel syndrome is caused by prolonged, increased pressure on the median nerve as it passes through a narrow
opening on the palm side of the wrist known as the carpal tunnel. The wrist itself is composed of eight bones that make up
three sides of the tunnel, and the transverse carpal ligament, which forms the fourth side. In addition to the median nerve,
tendons and blood vessels pass through the carpal tunnel. If any of the tendons swell, or if the tissues surrounding the carpal
tunnel become inflamed,
the space inside the carpal tunnel reduces, and the contents of the tunnel become crowded. Thus, the
median nerve gets squeezed and compressed, and eventually sends pain signals to the brain. The result is the discomfort,
tingling, and numbness that is characteristic of carpal tunnel syndrome.
Risk Factors
Carpal tunnel syndrome is most often seen in people whose jobs or hobbies require them to move their hands and wrists in
repetitive motions.
Occupations that have a high risk of developing carpal tunnel syndrome include the following:
- Computer operators
- Seamstresses
- Pianists and instrumental musicians
- Supermarket checkout clerks
- Jackhammer operators
- Assembly-line workers
The following medical conditions can cause swelling which may also contribute to the formation of carpal tunnel syndrome:
- Rheumatoid arthritis
- Connective tissue diseases (gouty arthritis, systemic lupus erythematous, amyloidosis)
- Diabetes
- Hypothyroidism
- Acromegaly
- Benign tumors or growths
- Obesity
- Wrist fracture, sprain, or dislocation
- Carpal tunnel syndrome is also common in pregnant women, who often experience fluid retention and swelling, which
compress nerves in the hands and wrists.
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a
certain condition. They are not necessarily "cause" of the condition.
Symptoms of Condition
- Numbness, burning, or tingling in the fingers or hands
- Sensory loss in fingers and hands, as if they had fallen asleep
- Loss of hand strength and dexterity
- Acute pain in the hands and wrists at night, often waking the person
- Pain aggravated by repetitive, manual activity
- For severe cases, pain may encompass the arm, shoulder, neck, and chest
Conditions That May Be Mistaken for Carpal Tunnel Syndrome
The differential diagnosis includes both local conditions of the wrist and hand, and more widespread conditions affecting
sensation and movement. Possibilities include the following:
- A displaced disk in the spine
- Damage to the network of nerves in the spine, forearm, or hand
- Disturbances to the nervous system
- Inflamation of a tendon sheath
- Arthritis
- Degenerative joint disease of the neck and spine
- General injury to the nerves in the arms
- Reynaud's syndrome or other circulatory diseases
- An improperly set fractured or dislocated wrist
- Angina pectoris, if pain occurs on left side
- Thoracic outlet syndrome
How Carpal Tunnel Syndrome Is Diagnosed
Physical examination from a physician may include the following tests:
- Electromyography (EMG), a test of nerve response, can detect an unusual delay in impulses to the hand. This test will yield
abnormal results for 85% of those with carpal tunnel syndrome.
- Phalen's test: Press the backs of the hands together so the wrists are completely flexed. If numbness or tingling is provoked in
60 seconds or less, it suggests a carpal tunnel problem.
- Tinel's test: Tap the wrist on the palm side. If tingling is felt in the fingers, it suggests a carpal tunnel problem.
- Tourniquet test: Inflate a blood pressure cuff around the upper arm. If tingling is produced in the fingers, it suggests a carpal
tunnel problem.
- If the bulk of muscles at the base of the thumb is atrophied, this suggests a more advanced carpal tunnel/median nerve
injury.
No particular laboratory test is standard for carpal tunnel syndrome. Thyroid function tests for hypothyroidism and
glucose studies may help to rule out endocrine and metabolic conditions which may be associated with carpal tunnel
syndrome.
X-ray images of the carpal tunnel may help rule out other conditions, but X-rays are of limited benefit.
Your Medical History
Your occupation and hobbies may cause you to make repetitive hand motions that put pressure on the median nerve of the
hand. The presence of other medical conditions such as rheumatoid arthritis or a sprained wrist may cause swelling that can
contribute to carpal tunnel syndrome.
Treatment Overview
Treatment of carpal tunnel syndrome reduces the symptoms -- pain and weakness -- or, more aggressively, treatment is
designed to structurally lessen the pressure on the median nerve. For a complete cure, sufferers will need to change their
behavior and avoid the activities that cause the stress and pressure to the nerve.
Generally, your doctor will try noninvasive ("nonsurgical") methods first. Initially, it is likely that you'll be fitted with a
wrist brace or a splint to restrict hand motion and reduce pressure on the inflamed nerve. You will also be encouraged to rest
hands and wrists often, or to avoid the irritating activity altogether. If you return to the repetitive motions that originally
triggered the syndrome, however, you can expect symptoms to return as well.
If your doctor has recommended wrist splints, prescribed medications, or given you cortisone injections for your condition,
you will require follow-up care. You should return to your doctor in four to 12 weeks to assess the success of your treatment.
If you have surgery to treat yourcarpal tunnel syndrome, it is unlikely that you will require routine follow-up visits to your
doctor once the incision has healed.
Drug Therapy
You may be given oral medications to temporarily reduce the inflammation and pain. Anti-inflammatory drugs are often
effective, but allow only temporary relief.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) and Aleve (naproxen) may be recommended first
by your doctor to relieve the symptoms.
Many other NSAIDs are alternately used to relieve pain and inflammation. They include the following:
- Feldene (piroxicam)
- Lodine (etodolac)
- Oruvail (ketoprofen)
- Relafen (nabumetone)
- Voltaren (diclofenac)
- Local Injections
Depending upon the severity of your case, your physician may inject a corticosteroid shot directly into the wrist to help
reduce swelling.
Surgery
In almost all advanced cases of carpal tunnel syndrome, outpatient surgery can effectively reduce pressure caused by swollen
tendons on the nerve.
A hand surgeon can remedy the pressure on the median nerve that is causing the pain and discomfort. In most cases, surgery
successfully alleviates the symptoms. This relatively simple procedure is usually done on an outpatient basis (no overnight
hospital stay required). If in addition to a local anesthetic your doctor recommends general anesthesia, you will be
hospitalized. In that case, be sure to have someone drive you to and from the hospital. You'll need a full day to completely
recover from the effects of the anesthesia.
The surgeon will first apply a tight bandage on your arm to restrict blood flow into the area to be operated on. The hand will
then be positioned palm up. The surgeon will create a small vertical incision in the wrist and then transect the hand's lateral
carpal ligaments to reduce the swelling and nerve pressure. When this is done, the incision will be closed with sutures and a
pressure dressing applied.
Pain relievers will be prescribed to you for postoperative comfort. The pressure dressing is usually left on for at least six
and as long as 24 hours. The dressing must be kept dry, so if you shower, be sure to place a plastic bag tightly over your
hand.
Healthcare Professionals Who May Be Involved in Treatment
Though you may first bring your problem to a general healthcare provider, a team of specialists may be necessary to alter
your behavior in the long term, to monitor the progress of your change in activities, to adjust your workstation or find more
ergonomic solutions to your job, or to perform hand or wrist surgery. It would not be unusual to seek help from the following:
-
Rheumatologists
- Primary care physicians
- Neurologists
- Orthopedic Surgeons
- Hand specialists in orthopedic surgery, neurosurgery, and plastic surgery
- Physical therapists
- Occupational therapists
- Ergonomists
- Physiatrists (rehabilitation doctors)
Activity and Diet Recommendations
Rest, frequent changes in hand positions, and wearing splint supports are often the best preventative measures as well as
effective remedies. However, a return to stressful repetitive motions may bring back symptoms. Avoid repetitive manual
activities, especially those that causeyou pain or discomfort.
- Avoid sudden wrist snapping, such as jerky flexing or extending.
- Rest your hands often. This may include modified duties at the workplace and postponing hand-intensive hobbies and chores.
- A variety of tasks can reduce intensive hand use. If possible, alternate hands to include the unaffected side.
- Forceful movements of the hands, including heavy lifting, gripping, and squeezing, should be curtailed.
- Improve the ergonomic adjustment of your workstation. For keyboardists, ergonomic keyboards are available. Your chair
should support your back. Monitors are best placed at eye level. Keep wrists straight by using wrist supports in front of the
keyboard.
- Wear splints at night and when performing repetitive activities.
- Make sure any tools you use are properly fitted to your hand. Reduce the amount of turning, gripping, and squeezing you do
with your hands.
- Use both hands for tasks, rather than further stress your injured hand.
Do gentle hand exercises and stretches to increase your hand flexibility without aggravating your injury. Your doctor, nurse,
physical therapist, or occupational therapist can show you how to strengthen all your hand and wrist muscles, and put less
strain on the injured area.
Quality of Life
Carpal tunnel syndrome can cause profound changes in the way you work. It is widely believed that the syndrome results
directly from repetitive motions of the hand and wrist, so to prevent a reoccurrence, you may have to adjust your work
activities. In some instances, you may be advised to discuss a change in duties with your supervisor, reevaluate your skills,
or possibly retrain for work that is less strenuous on your hands. Luckily, carpal tunnel is fairly easy to avoid and simple to
treat.
Considerations for Pregnant Women
Pregnant women are more susceptible to carpal tunnel syndrome since hormonal changes and fluid retention can put pressure
on the median nerve. Carpal tunnel syndrome during pregnancy may be a temporary condition that will resolve on its own
after childbirth, so it is usually treated with nonsurgical methods.
Alternative Care
Supplements
Bromelain is an anti-inflammatory enzyme found in pineapple, and is available as a supplement. Several studies show that it
decreases pain and swelling. Naturopaths often prescribe it for carpal tunnel syndrome -- 250 mg to 500 mg twice a day
between meals.
HerbsWillow bark is a form of herbal aspirin. It contains salicin, the natural precursor of the familiar pain reliever. Like
aspirin, willow bark is an anti-inflammatory pain reliever. Simmer two teaspoons of powdered bark in a cup of boiling
water for 10 minutes. Cool, strain, and drink up to two cups a day. When using a commercial preparation, follow package
directions. [1]
St. John's wort helps to prevent the depression that can come with the pain of carpal tunnel syndrome. Doctors increasingly
prescribe antidepressants to treat chronic pain problems. Naturopaths and herbalists suggest St. John's wort as an effective
herbal antidepressant in the treatment of carpal tunnel syndrome. Follow package directions.
Acupuncture
An ancient Chinese practice, acupuncture consists of inserting very fine needles into the skin along a series of energy
channels or paths known as meridians. It stimulates particular areas or systems of the body to promote healing and wellness.
In one study, acupuncture substantially relieved carpal tunnel symptoms in 35 out of 36 people, 14 of whom had not benefited
from surgery.
Chiropractic, Osteopathy, and Massage
The various manipulative therapies all have testimonial support, and physical therapy can be very helpful in recovery.
Preventing Carpal Tunnel Syndrome
Stretching exercises for the hands and wrists can help eliminate the need for surgery. Typically, these are warm-up exercises
designed to prepare your median nerve for repeated activity. A physical/occupational therapist can teach you appropriate
exercises.
A physical therapist can also examine your work environment and help you set up an arrangement to minimize stress on your
hands and wrists. He or she will inspect the type and height of your chair and its distance from a computer keyboard, if you
use one. You may need to use a wrist rest to keep from overextending your wrists while typing, a frequent cause of carpal
tunnel syndrome.
You can warm up your hands before work by massaging and stretching your fingers, flexing your wrists, and opening and
closing your fists.
Self-Care Measures
Adjust your keyboard and chair so that your wrists are straight or bent slightly downward. Wrists should be at or above --
not below -- finger level. Consider a wrist-supporting foam pad to keep your wrists above your fingers.
Adjust your monitor so that its center is at or below eye level.
Adjust your chair so that your feet are flat on the floor and your lower back is well supported. If your chair doesn't provide
adequate support to your lower back, consider using a cushion or even a rolled-up towel to provide supplemental support.
You may feel more comfortable and have fewer symptoms if you swap your regular keyboard for a split, ergonomic model.
Alternative pointing devices, such as an ergonomic mouse, trackball, trackpad, or footswitch, may be helpful.
Take frequent mini-breaks to keep your circulation going and give your hands a rest from the keyboard. Also, keep your
hands and fingers warm to keep muscles and tendons relaxed.
Consider a wrist splint. Available at medical supply stores and pharmacies, these devices hold your wrist snugly in a
near-straight position, keeping your carpal tunnel open. In one study, 331 people with carpal tunnel syndrome took
anti-inflammatory medication and wore splints. Two-thirds of the group reported significant relief.
If you are overweight, lose some pounds. The more you weigh, the more likely you are to suffer carpal tunnel syndrome.
Extra pounds mean excess wrist tissue, which compresses the median nerve.
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