Carpal Tunnel Syndrome

The carpal tunnel is a narrow space inside the wrist. It is ringed by bone and a band of tough tissue called the transverse carpal ligament. A major nerve called the median nerve runs from the forearm into the hand through the carpal tunnel. Tendons also run through the carpal tunnel.

With carpal tunnel syndrome, the tendons or nearby tissues within the carpal tunnel may swell or thicken or the transverse carpal ligament may harden and shorten. This narrows the space in the carpal tunnel and puts pressure on the median nerve. This pressure leads to tingling and numbness of the hand and wrist. In time, the condition can make even simple tasks hard to do.

Most cases of carpal tunnel syndrome have no specific cause. But any or all of the following may be part of the cause:

• Frequent, repetitive, small movements with the hands such as with typing or using a keyboard.

• Frequent, repetitive, grasping movements with the hands such as with sports and certain physical activities.

• Joint or bone disease. For example, arthritis, osteoarthritis or rheumatoid arthritis.

• Hormonal or metabolic changes. For example, menopause, pregnancy or thyroid imbalance.

• Changes in blood sugar levels. For example, with Type 2 diabetes.

• Other conditions or injuries of the wrist. For example, strain, sprain, dislocation, break or swelling and inflammation.

• Family history of carpal tunnel syndrome.

Symptoms often come and go. At first, symptoms may occur mainly at night. Later, they may be noticed during the day as well. They may get worse with activities such as driving, reading, typing, or holding a phone. Symptoms can include:

• Weakness when gripping objects with one or both hands.

• Pain or numbness in one or both hands.

• "Pins and needles" feeling in the fingers.

• Swollen feeling in the fingers.

• Burning or tingling in the fingers, especially the thumb and the index and middle fingers.

• Pain or numbness that is worse at night, interrupting sleep.

Women get carpal tunnel syndrome 3 times more often than men. It usually occurs only in adults.

Your provider will check your health history and perform a physical exam. He or she may recommend electrodiagnostic testing of your nerves. These tests are helpful in diagnosing carpal tunnel syndrome. Electrodiagnostic tests stimulate the muscles and nerves in your hand to see how well they work. Ultrasound of the nerve may be performed at the same time as a nerve conduction study or EMG.  This test does not require any needles or electrodes and may evaluate the compression of the nerve as it crosses the wrist.

Your healthcare provider will discuss different treatment options with you. Treatment will depend on your symptoms, age and general health. It will also depend on how severe the condition is. Choices for treatment may include one or more of the following:

• Wrist splint. This involves wearing a special brace on the wrist and hand. The splint holds the wrist straight, in a neutral position. This helps keep the carpal tunnel as open as possible.

• Corticosteroid shots. Corticosteroids are a type of medicine that helps reduce swelling. It is injected directly into the wrist. It helps shrink tissues inside the carpal tunnel. This relieves symptoms for a time.

• Pain medicines. You may take over-the-counter or prescription medicines to help reduce swelling and relieve symptoms.

• Worksite changes. Changing position of your computer keyboard or making other ergonomic changes can help ease symptoms.

• Exercise. Stretching and strengthening exercises can help when your symptoms are better. A physical or occupational therapist may watch you do the exercises.

• Surgery. If the condition doesn’t respond to other treatments and doesn’t go away on its own, you may need surgery. During surgery, the surgeon cuts the transverse carpal ligament to relieve pressure on the median nerve.