What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTR), also called median nerve compression, is a common condition that causes numbness, tingling and/or pain in the hand and forearm. The carpal tunnel is an opening in the wrist formed by the carpal bones on the bottom of the wrist and the transverse carpal ligament across the top of the wrist. Carpal tunnel syndrome occurs when the median nerve — one of the major nerves to the hand — becomes squeezed or compressed as it travels through the carpal tunnel.
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Carpal Tunnel Syndrome Causes
Most cases of carpal tunnel syndrome do not have a specific cause. But any or all of the following may contribute to the development of the condition:
- Repetitive, frequent, small movements with the hands, including those associated with typing or using a keyboard
- Repetitive, frequent, grasping movements with the hands, such as those associated with sports and certain physical activities
- Joint or bone disease — for example, arthritis, rheumatoid arthritis or osteoarthritis
- Changes in blood sugar levels, such as those associated with type 2 diabetes
- Hormonal or metabolic changes — for example, those caused by pregnancy, thyroid imbalance or menopause
- Other conditions or injuries of the wrist, including sprain, strain, break, dislocation, or swelling and inflammation
- Family history of carpal tunnel syndrome
What Are the Symptoms of Carpal Tunnel Syndrome?
Common symptoms of carpal tunnel syndrome include:
- Pain or numbness in one or both hands
- Weakness when grasping objects with one or both hands
- A “pins and needles” sensation in the fingers
- Swollen feeling in the fingers
- Burning or tingling in the fingers, especially the index and middle fingers and the thumb
- Pain or numbness in the hand or hands that worsens at night and interrupts sleep
Health conditions other than carpal tunnel syndrome can cause the symptoms listed above. As such, always consult a health care provider for a proper diagnosis.
Carpal Tunnel Syndrome Diagnosis
Your health care provider will conduct a physical exam and review your health history. They may order electrodiagnostic tests on your nerves to help with the diagnosis and rule out other causes of hand and wrist pain. These tests stimulate the nerves and muscles in your hand to assess how well they function. Your doctor may also order an imaging test (ultrasound, X-ray or MRI) to help determine the cause of your symptoms. In addition, your doctor may order blood work or other lab tests to look for diseases such as diabetes that can damage nerves.
What Are Carpal Tunnel Syndrome Risk Factors?
Carpal tunnel syndrome primarily affects adults. Women are three times more likely to get the condition than men. Certain underlying health problems, such as diabetes or kidney failure, can put you at higher risk for nerve compression disorders such as carpal tunnel syndrome.
Carpal Tunnel Syndrome Treatment
Your doctor will discuss treatment options with you. Treatment will depend on your symptoms, the severity of your condition, your age and your overall health.
Treatment of carpal tunnel syndrome may include:
- Splinting your hand to keep your wrist from moving; splinting also eases the compression of the nerves inside the carpal tunnel
- Worksite changes such as altering the position of your keyboard or other ergonomic changes that help ease symptoms
- Anti-inflammatory medicines taken by mouth or injected into the carpal tunnel space to ease swelling
- Exercise, including stretching and strengthening exercises to do once symptoms improve. A physical or occupational therapist may watch you do the exercises. Your physician may also recommend yoga.
- Your doctor may recommend surgery if your condition doesn’t improve with other treatments or resolve on its own. The surgery, called carpal tunnel release, eases compression on the nerves in the carpal tunnel. Carpal tunnel release surgery is performed using one of two methods:
- Open Carpal Tunnel Release: In open carpal tunnel release surgery, the doctor makes a small incision in the palm of your hand and views the inside of your hand and wrist through this incision. The doctor then divides the transverse carpal ligament (the roof of the carpal tunnel) using a special knife. This action decreases pressure on the median nerve by increasing the size of the carpal tunnel. Following surgery, the ligament can gradually grow back together in the widened carpal tunnel, resulting in reduced pressure on the median nerve.
- Endoscopic Carpal Tunnel Release: In the endoscopic version, the doctor makes one or two small skin incisions through which a miniature camera (endoscope) is inserted that allows the doctor to see inside your hand and wrist. Similar to the open carpal tunnel release procedure, the doctor uses a special knife to divide the transverse carpal ligament.