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Carpal Tunnel Syndrome

Definition

Carpal tunnel syndrome is a nerve disorder of the hand. It is caused by compression of the median nerve. The median nerve gets squeezed inside a narrow passage in the wrist called the carpal tunnel. This nerve provides feeling to the thumb, index and middle fingers, and half the ring finger.
Carpal Tunnel Syndrome
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Causes

Carpal tunnel syndrome is created by pressure on the median nerve. This pressure is caused by the carpal tunnel becoming narrower. The narrowing can be caused by many factors, including:
  • Swelling of tissue in the carpal tunnel due to injury or fluid changes in your body
  • Hereditary narrow carpal tunnel
  • Tumors (rare)

Risk Factors

Women and older adults are at greater risk for carpal tunnel syndrome.
Factors that may increase your risk of carpal tunnel syndrome include:

Symptoms

Carpal tunnel syndrome causes symptoms in one or both hands or wrists. Symptoms may include:
  • Tingling, burning, or numbness, especially in your thumb and index or middle fingers
  • Pain or numbness that worsens with:
    • Wrist, hand, or finger movement
    • Sleep—symptoms may wake you
  • Hand stiffness or cramping that gets better after:
    • Shaking your hand
    • Waking up in the morning
  • Weakness or clumsiness of your hand:
    • Loss of grip strength
    • Difficulty making a fist
    • Frequently dropping things
  • Pain that moves up your arm

Diagnosis

You will be asked about your symptoms and medical history. A physical exam of your arms, wrists, and hands will be done. The exam will include tests of strength, sensation, and signs of nerve irritation or damage.
Other tests may include:
  • Electrodiagnostic exam —Measures and records the speed of electrical conduction in your median nerve to see if the nerve impulse in the hand is delayed
  • MRI scan —A test that uses magnetic waves to make pictures of structures inside your body, in this case the neck
  • X-ray —A test that uses radiation to take a picture of structures inside your body, especially bones
  • Ultrasound—A test that uses sound waves to measure the width of your median nerve (may be used as a screening test or to guide injections)

Treatment

It is important to correct whatever is causing the carpal tunnel syndrome. Sometimes making simple changes in your workplace or home may help relieve symptoms.
Treatment may also include:

Rest, Ice, Elevation, and Exercises

  • Rest your wrist by keeping it straight and decreasing activities that worsen pain.
  • Gently apply ice packs to the area.
  • Elevate the hand above your heart to reduce swelling.
  • Do exercises as directed by your healthcare provider.

A Wrist Splint

A splint will prevent extreme movements of the wrist. It is most effective when worn at night. It can help you avoid waking up with symptoms.

Medications

  • Over-the-counter pain relievers such as aspirin and ibuprofen
  • Injection of cortisone into the carpal tunnel

Surgery

Surgery may be needed if symptoms are severe, or continue after you try other treatments. The most common procedure is the carpal tunnel release .

Prevention

You may reduce your chances of getting carpal tunnel syndrome by taking these steps:
  • Minimize repetitive hand movements when possible.
  • Alternate between activities or tasks to reduce the strain on your body.
  • When using your wrists, keep them straight. Let your arms and shoulders share the stress.
  • Use your whole hand or both hands to pick up an item.
  • Avoid holding an object the same way for a long time.
  • If you work in an office, adjust your desk, chair, and keyboard so you are in the best possible position:
    • Back straight
    • Feet flat on the floor or resting on a footrest
    • Knees level with or slightly lower than your hips
    • Shoulders in a neutral position, not forward or back
    • Elbows bent at a 90-degree angle
    • Forearms parallel to the floor and wrists straight
  • Take breaks at least every hour to:
    • Rest or shake your hands
    • Massage your palms and backs of your hands
  • Get regular aerobic exercise such as walking or swimming.
  • Cut down on caffeine and smoking . These activities may reduce blood flow to your hands.

RESOURCES

American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org

American Association of Neurological Surgeons http://www.aans.org

CANADIAN RESOURCES

Canadian Centre for Occupational Health and Safety http://www.ccohs.ca

Canadian Physiotherapy Association http://www.physiotherapy.ca

References

Carpal tunnel syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed September 9, 2014.

Carpal tunnel syndrome. The Female Patient. 1997;21-30.

Carpal tunnel syndrome: how you can help your patient overcome the symptoms. Consultant. 1994.

Cartwright MS, Hobson-Webb L, et al. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012 Aug;46(2):287-93.

JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011 Apr;469(4):1089-94. ns; 2005: chap 36

Fowler JR, Gaughan JP, et al. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011 Apr;469(4):1089-94.

Hunderfund AN, Boon AJ, et al. Sonography in carpal tunnel syndrome. Muscle Nerve. 2011 Oct;44(4):485-491.

Katz RT. Carpal tunnel syndrome: a practical review. Am Fam Physician. 1994;49:1371-1379, 1385-1386.

Ly-Pen D, Andréu JL, et al. Comparison of surgical decompression and local steroid injection in the treatment of carpal tunnel syndrome: 2-year clinical results from a randomized trial. Rheumatology (Oxford). 2012 Aug;51(8):1447-54.

NINDS carpal tunnel syndrome information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/carpal%5Ftunnel/carpal%5Ftunnel.htm. Updated September 5, 2014. Accessed September 9, 2014.

O'Connor D, Page MJ, et al. Ergonomic positioning or equipment for treating carpal tunnel syndrome. Cochrane Database Syst Rev. 2012 Jan 18;1.

Page MJ, O'Connor D, et al. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012 Jun 13;6.

Rayan GM. Understanding and managing carpal tunnel syndrome. Journal of Musculoskeletal Medicine. 1999;654.

Shores JT, Lee WP. An evidence-based approach to carpal tunnel syndrome. Plast Reconstr Surg. 2010 Dec;126(6):2196-2204.

Steyers CM, Schelkun PH. Practical management of carpal tunnel syndrome. Phys Sportsmed. 1995:83.

Whitley JM, McDonnell DE. Carpal tunnel syndrome. Postgraduate Medicine. 1995;97:89-92,95-96.

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