What Is Carpal Tunnel Syndrome?

In This Article

Carpal tunnel syndrome (CTS) is a condition in which compression of a nerve in the wrist—the median nerve—produces tingling, numbness, weakness, and pain in the hand and fingers. Early diagnosis is key to preventing permanent nerve damage and typically involves a physical examination, functional tests, and X-rays. Treatment for carpal tunnel syndrome ranges from conservative approaches such as icing, splints, and pain medication to cortisone injections. Some people find relief from acupuncture, but severe symptoms may require surgery.

Also Known As

  • Compression neuropathy, carpal tunnel
  • Distal median nerve compression
  • Median neuropathy, carpal tunnel

Carpal Tunnel Anatomy

The carpal tunnel is a narrow passage in the wrist formed by the wrist bones on the bottom and sides and, on top, a strong band of connective tissue (a ligament) called the flexor retinaculum. The hand's main nerve, the median nerve, and the nine tendons that move and flex the first three fingers extend through the tunnel. Each of the tendons is wrapped in a fluid-filled membrane, the synovium, that can swell under certain conditions and press against the transverse ligament, which in turn constricts the median nerve.

Carpal Tunnel Syndrome Symptoms

The onset of carpal tunnel syndrome typically involves burning, numbness, and tingling in the thumb, index, and/or middle finger of one hand. These symptoms, which tend to affect in the dominant hand, come and go.

carpal tunnel syndrome symptoms
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You're most likely to notice carpel tunnel syndrome pain during the night, when your hands are still and fluid is better able to accumulate in the synovium. As the syndrome progresses, you may experience symptoms during the day, especially when you are using your hand to do activities that require gripping.Shaking out your hand may temporarily relieve the discomfort and numbness.

Over time, however, numbness can become constant. You may also experience weakness in the hands, clumsiness, decreased grip strength, and difficulty doing tasks for which you need manual dexterity. If carpal tunnel syndrome is left untreated, it can result in muscle damage.

Causes and Risk Factors

CTS can develop under a number of circumstances. The factors most often associated with causing carpal tunnel syndrome are:

  • Long-term repetitive movements of the fingers, hands, and wrists, such as typing, texting, and playing piano: The risk is greater among certain professions such as assembly line workers in manufacturing, hair dressers, cashiers, and dental practitioners. Research findings have been mixed about the link between carpal tunnel syndrome and long-term computer use.
  • Dislocation or fracture of the wrist: Such an injury may create a change in pressure in the carpal tunnel. This increases the chances for median nerve damage.
  • Obesity: Excess weight is associated with fluid retention that can be a factor in increases in synovial fluid.
  • Pregnancy or menopause: Fluid retention that occurs during both of these periods in a woman's life can increase pressure on the median nerve.
  • Rheumatoid arthritis: Swelling of the joints that is a hallmark of this chronic condition can put pressure on the median nerve.
  • Diabetes: The prevalence of carpal tunnel syndrome is relatively high among people with diabetes although why this is the case is unclear.
  • Family history: Carpal tunnel syndrome is not inherited but having a close relative with the disorder can boost the odds of getting it.
  • Hypothyroidism: People with a sluggish thyroid tend to accumulate fluid in their connective tissues.
  • Obstructions within the carpal tunnel, such as a cyst or tumor can also put pressure on the median nerve.

Women are three times more likely than men to develop carpal tunnel syndrome simply because of their smaller anatomy.

Diagnosis

Early diagnosis of carpal tunnel syndrome is important for preventing potentially permanent disability. It will start with a physical examination of your hands, wrists, neck, and shoulders, typcially followed by any of several tests used to diagnose carpal tunnel syndrome, including:

  • X-rays to rule out another cause of wrist pain, such as a fracture or arthritis
  • Tinel’s sign test, in which a doctor taps over the median nerve at the wrist to see if it creates a tingling sensation in the fingers
  • Wrist flexion test (or Phalen test), which simply requires you to allow your wrist to fall forward freely. If doing so causes numbness and tingling in the fingers within one minute, CTS is likely. The sooner these sensations appear during this test, the more severe the carpal tunnel syndrome is.
  • Electromyogram (EMG), which evaluates the electrical activity in the muscles of the arm and hand
  • Nerve conduction study, which measures how well the nerves are conducting signals

Treatment

There are many ways to treat carpal tunnel syndrome, depending on the severity of the condition. Those who have mild symptoms can relieve wrist pain by frequently resting their arms, avoiding strenuous physical activity and movements of the arms, and applying ice packs if there is swelling.

Carpal Tunnel Syndrome Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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If these measures do not bring relief within a few weeks, more aggressive ones may be helpful:

  • Wrist splinting to relieve pressure on the nerve and reduce tingling and numbness, especially at night
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) or Aleve (naproxen), to help reduce swelling while providing temporary pain relief
  • Corticosteroid injections to decrease swelling and inflammation of the median nerve that is resistant to NSAIDs
  • Acupuncture, which can alleviate wrist pain and restore dexterity.
  • Physical therapy: Customized exercises can help manage symptoms and are highly effective and noninvasive.
  • Some chiropractic techniques have been shown to give relief to people with CTS.
  • Surgery is an option if other treatments aren't effective. The goal of carpal tunnel surgery is to relieve pressure on the median nerve by cutting (releasing) the transverse carpal ligament producing the pressure that is irritating the nerve. This can be done endoscopically or with open surgery.

Prevention

You can help reduce your risk of carpal tunnel syndrome by making some relatively easy lifestyle changes, including:

  • Stick to a healthy body weight.
  • Manage conditions such as diabetes and rheumatoid arthritis that contribute to this condition.
  • Do wrist-stretching exercises.
  • Maintain good posture while everyday tasks—especially if you use a keyboard all day. Position your computer so that you don't have to flex your wrists as you type.
  • Wear splints at night to keep your wrists straight and try not to sleep on your wrists.
  • If you perform repetitive tasks at work or home, take frequent breaks and change your hand and body position often.

A Word From Verywell

Coping with carpal tunnel syndrome can be frustrating. You use your hands in many ways and so pain, numbness, and other bothersome sensations can have a direct effect on your ability to work and enjoy activities that require the use of your fingers and hands. CTS is entirely manageable, though, so the sooner you see a doctor about weird sensations in your hands, the simpler it will be to correct the problem.

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Article Sources
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