What are the early signs of carpal tunnel syndrome. How is carpal tunnel syndrome diagnosed. What are the most effective treatments for carpal tunnel syndrome. Can carpal tunnel syndrome be prevented. Who is at higher risk of developing carpal tunnel syndrome. How long does it take to recover from carpal tunnel syndrome. What lifestyle changes can help manage carpal tunnel syndrome.

Understanding Carpal Tunnel Syndrome: A Comprehensive Overview

Carpal tunnel syndrome (CTS) is a prevalent neurological condition that affects millions of people worldwide. It occurs when the median nerve, which runs from the forearm to the palm, becomes compressed or squeezed at the wrist. This compression can lead to a range of symptoms, from mild discomfort to severe pain and loss of hand function.

What Exactly Is the Carpal Tunnel?

The carpal tunnel is a narrow passageway located at the base of the hand, formed by ligaments and bones. This tunnel houses the median nerve and the tendons that control finger movement. When the tunnel narrows or swells, it can put pressure on the median nerve, resulting in the symptoms associated with CTS.

Recognizing the Symptoms of Carpal Tunnel Syndrome

Identifying the early signs of CTS is crucial for timely intervention and effective management. The symptoms typically develop gradually and may include:

• Numbness or tingling in the thumb, index, middle, and part of the ring finger
• A sensation of swollen or useless fingers, especially upon waking
• Pain or discomfort in the hand and wrist, often worse at night
• Weakness in the hand, making it difficult to grasp small objects
• In severe cases, loss of temperature sensation in the fingertips

Do these symptoms always indicate carpal tunnel syndrome? While these signs are characteristic of CTS, it’s important to note that similar symptoms can be caused by other conditions. Therefore, a professional diagnosis is essential to rule out other potential issues.

Risk Factors and Causes of Carpal Tunnel Syndrome

CTS often results from a combination of factors that increase pressure on the median nerve. Some of the most common risk factors include:

1. Repetitive hand and wrist movements
2. Certain medical conditions like diabetes, rheumatoid arthritis, and thyroid disorders
3. Pregnancy and menopause due to hormonal changes
4. Wrist injuries or fractures
5. Genetic predisposition

Is carpal tunnel syndrome more common in certain professions? While CTS can affect individuals in various occupations, it is more frequently reported among those whose work involves repetitive hand movements or the use of vibrating tools. This includes assembly line workers, seamstresses, and even office workers who spend long hours typing.

Diagnosing Carpal Tunnel Syndrome: From Physical Exams to Advanced Tests

Accurate diagnosis of CTS is crucial for effective treatment. Healthcare providers typically use a combination of methods to confirm the condition:

Physical Examination

A thorough physical exam is the first step in diagnosing CTS. The doctor will assess the strength, sensation, and appearance of your hands, arms, shoulders, and neck. They may also perform specific tests to reproduce CTS symptoms:

• Tinel’s sign: Tapping on the median nerve to elicit tingling in the fingers
• Phalen’s maneuver: Flexing the wrist to see if symptoms occur within 60 seconds
• Two-point discrimination test: Checking sensation in the fingertips

Electrodiagnostic Tests

For a more definitive diagnosis, your doctor may recommend electrodiagnostic tests:

• Nerve conduction study: Measures how quickly electrical impulses move through the median nerve
• Electromyography (EMG): Evaluates the electrical activity of muscles when they contract and when at rest

Are these tests painful? While they may cause some discomfort, most patients find electrodiagnostic tests tolerable. The information they provide is invaluable for confirming the diagnosis and determining the severity of CTS.

Treatment Options: From Conservative Approaches to Surgical Interventions

The treatment for CTS depends on the severity of the condition and how long symptoms have been present. Options range from conservative measures to surgical intervention:

Non-Surgical Treatments

• Wrist splinting: Wearing a splint at night can help keep the wrist in a neutral position
• Nonsteroidal anti-inflammatory drugs (NSAIDs): To reduce pain and inflammation
• Corticosteroid injections: Provide temporary relief by reducing swelling around the median nerve
• Physical therapy: Exercises to strengthen the hand and wrist
• Lifestyle modifications: Ergonomic adjustments at work and home

Surgical Options

When conservative treatments fail to provide relief, surgery may be recommended. The most common surgical procedure for CTS is carpal tunnel release, which can be performed using two techniques:

1. Open release surgery: A larger incision is made to access and cut the carpal ligament
2. Endoscopic surgery: Smaller incisions and the use of a tiny camera for a less invasive approach

How long does recovery take after carpal tunnel surgery? Most patients experience significant improvement within a few weeks to a few months after surgery. However, full recovery, particularly in terms of grip and pinch strength, may take several months.

Preventing Carpal Tunnel Syndrome: Proactive Measures for Hand Health

While not all cases of CTS can be prevented, there are several steps you can take to reduce your risk:

• Practice proper ergonomics at work and home
• Take regular breaks from repetitive activities
• Maintain good overall health and manage underlying conditions
• Perform hand and wrist stretching exercises regularly
• Use tools and equipment designed to reduce hand strain

Can lifestyle changes really make a difference in managing CTS? Absolutely. Many patients find significant relief by implementing ergonomic changes and adopting healthier habits. However, it’s important to combine these measures with professional medical advice for the best outcomes.

Living with Carpal Tunnel Syndrome: Coping Strategies and Long-Term Outlook

For those diagnosed with CTS, learning to manage the condition is key to maintaining quality of life and preventing further complications. Here are some strategies that can help:

Adaptive Techniques and Tools

• Use voice recognition software to reduce typing
• Invest in ergonomic keyboards and mouse devices
• Try compression gloves designed for CTS
• Use jar openers and other assistive devices for daily tasks

Pain Management Techniques

Beyond medication, several non-pharmacological approaches can help manage CTS pain:

• Cold therapy: Applying ice packs to reduce inflammation
• Heat therapy: Using warm compresses to improve circulation
• Gentle massage: To alleviate muscle tension in the hands and wrists
• Acupuncture: Some patients report relief from this alternative therapy

What is the long-term outlook for people with carpal tunnel syndrome? With proper treatment and management, most individuals with CTS can expect significant improvement in their symptoms. However, in severe cases or those left untreated for extended periods, some nerve damage may be permanent, emphasizing the importance of early intervention.

Carpal Tunnel Syndrome in Special Populations: Considerations and Challenges

While CTS can affect anyone, certain groups may face unique challenges or require special considerations in their treatment approach:

Pregnant Women

CTS is common during pregnancy due to hormonal changes and fluid retention. For most women, symptoms resolve after delivery, but management during pregnancy requires careful consideration of treatment options safe for both mother and baby.

Diabetic Patients

Individuals with diabetes are at higher risk for CTS and may experience more severe symptoms due to existing nerve damage. Careful blood sugar control is crucial in managing CTS in this population.

Elderly Individuals

Older adults may have pre-existing conditions that complicate CTS treatment. They may also take longer to recover from surgical interventions, necessitating a more conservative approach initially.

How do treatment approaches differ for these special populations? Healthcare providers must tailor their treatment plans to address the unique needs and risks of each group. This may involve more frequent monitoring, alternative therapies, or modified surgical techniques when necessary.

The Future of Carpal Tunnel Syndrome Management: Emerging Treatments and Research

As our understanding of CTS continues to evolve, researchers are exploring new treatments and preventive strategies:

Regenerative Medicine

Stem cell therapy and platelet-rich plasma (PRP) injections are being studied for their potential to promote nerve healing and reduce inflammation in CTS patients.

Wearable Technology

Smart devices that monitor hand and wrist movements throughout the day may help identify risk factors and provide real-time feedback to prevent CTS development.

Minimally Invasive Surgical Techniques

Advancements in surgical technology are leading to even less invasive procedures with faster recovery times and reduced scarring.

What can we expect from future CTS treatments? While it’s difficult to predict specific breakthroughs, the trend towards personalized medicine suggests that future treatments will be increasingly tailored to individual patients based on their genetic makeup, lifestyle factors, and specific symptoms.

In conclusion, carpal tunnel syndrome is a complex condition that requires a multifaceted approach to diagnosis, treatment, and management. By understanding the causes, recognizing early symptoms, and exploring the range of available treatments, individuals affected by CTS can take proactive steps towards relief and recovery. As research continues to advance, we can look forward to even more effective and personalized approaches to managing this common neurological disorder.

Carpal Tunnel Syndrome | National Institute of Neurological Disorders and Stroke

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is a common neurological disorder that occurs when the median nerve, which runs from your forearm into the palm of the hand, becomes pressed or squeezed at the wrist. You may feel numbness, weakness, pain in your hand and wrist, and your fingers may become swollen and useless. You might wake up and feel you need to “shake out” your hand or wrist.

The median nerve and the tendons that bend the fingers pass through the carpal tunnel—a narrow, rigid passageway of ligament and bones at the base of the hand. The median nerve provides feeling to the thumb, index, and middle finger, and part of the ring finger (but not the little finger). It also controls some small muscles at the base of the thumb.

Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and compresses the median nerve. CTS is the most common and widely known of the entrapment neuropathies, in which one of the body’s peripheral nerves is pressed on or squeezed.

You can sometimes treat carpal tunnel syndrome at home, but it may take months to heal. Your doctor can recommend treatments. CTS rarely recurs following treatment and home care.

Symptoms

Symptoms usually start gradually, with frequent numbness or tingling in the fingers, especially the thumb and the index and middle fingers. Symptoms often first appear in one or both hands during the night. The dominant hand is usually affected first and procures the most severe symptoms. Early symptoms include:

• Numbness, particularly at night  
• A feeling the fingers are useless or swollen
• A tingling sensation or pain in the fingers.

As symptoms worsen, people might feel:

• Tingling during the day, especially with certain activities such as talking on the phone, reading a book or newspaper, or driving

• Mild to severe pain, sometimes worse at night 
• Some loss of movement in the hand

• Hand weakness may make it difficult to grasp small objects or perform other manual tasks.

In chronic and/or untreated cases, the muscles at the base of the thumb may shrink and waste away. Some people with very severe CTS cannot determine between hot and cold by touch and may burn their fingertips without knowing it.

Who is more likely to get carpal tunnel syndrome?

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Sometimes no single cause can be identified. Contributing factors may include:

• Trauma or injury to the wrist that cause swelling, such as sprain or fracture
• Imbalance of either the pituitary gland or the thyroid gland
• Rheumatoid arthritis or other arthritic diseases
• Mechanical problems in the wrist joint
• Repeated use of vibrating hand tools
• Fluid retention during pregnancy or menopause
• Development of a cyst or tumor in the canal
• Sex—women are three times more likely than men to develop CTS
• Having diabetes or other metabolic disorders that directly affect the body’s nerves and make them more susceptible to compression
• Repeated sleeping on a bent wrist
• Increasing age—CTS usually occurs only in adults.

The risk of developing CTS is not confined to people in a single industry or job but may be more reported in those performing assembly line work—such as manufacturing, sewing, finishing, cleaning, and meatpacking—than it is among data-entry personnel. Many people who have CTS report never have working at these types of jobs.

How is carpal tunnel syndrome diagnosed and treated?

Diagnosing CTS

Early diagnosis and treatment are important to avoid permanent damage to the median nerve.

• Physical exam. Your doctor will examine your hands, arms, shoulders, and neck to determine if your complaints are related to daily activities or to an underlying disorder and to rule out other conditions that mimic carpal tunnel syndrome. Your wrist will be checked for tenderness, swelling, warmth, and discoloration. Your fingers will be tested for sensation, along with muscles at the base of the hand for strength and signs of atrophy.
• Routine laboratory tests and X-rays can reveal fractures, arthritis, and nerve-damaging diseases such as diabetes.
• Specific wrist tests may produce the symptoms of CTS.
  • In the Tinel test, the doctor taps on or presses on the median nerve in your wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs.
  • The Phalen, or wrist-flexion, test involves having you hold your forearms upright by pointing the fingers down and pressing the backs of the hands together. If you have CTS, you should feel tingling or increasing numbness in your fingers within 1 minute. Your doctor may also ask you to try to make a movement that brings on symptoms.
• Electrodiagnostic tests may help confirm the diagnosis of CTSs.
  • A nerve conduction study measures how quickly impulses are transmitted along a nerve. Electrodes are placed on your hand and wrist and a small electric shock is  applied and the speed with which nerves transmit impulses is measured
  • In electromyography, a fine needle is inserted into a muscle and electrical activity is viewed on a screen to determine the severity of damage to the median nerve.
• Diagnostic imaging also can help diagnose CTS or show problems.
  • Ultrasound imaging can show an abnormal size of the median nerve.
  • Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.

Treating CTS

Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor’s direction.  Underlying causes such as diabetes or arthritis should be treated first.

Non-surgical treatments

• Splinting.   Initial treatment is usually a splint worn at night.
• Avoiding daytime activities that may provoke symptoms.  If you have slight discomfort you may wish to take frequent breaks from tasks, to rest the hand.  If the wrist is red, warm and swollen, applying cool packs can help.
• Over-the-counter drugs.  In special circumstances, various medications can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and other nonprescription pain relievers, may provide some short-term relief from discomfort but haven’t been shown to treat CTS.
• Prescription medicines.  Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into your wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve if you have mild or intermittent symptoms. (Check first with your doctor if you have diabetes or may be predisposed to it, as prolonged use of corticosteroids can make it difficult to regulate insulin levels. )
• Exercise. Ask your doctor about hand exercises that might help with pain.
• Alternative therapies. Yoga has been shown to reduce pain and improve grip strength among those with CTS. Other alternative therapies, such as acupuncture and chiropractic care, have benefited some people with CTS but their effectiveness remains unproved.
• Vocational or occupational therapy. You may need to learn new ways to perform certain tasks or job skills that will not complicate or worsen your CTS.

Surgery

• Carpal tunnel release is one of the most common surgical procedures in the United States. It may be recommended when non-surgical treatments are ineffective or if the disorder has become severe. Carpal tunnel surgery involves cutting a ligament to relieve the pressure on the nerve. Surgery is usually done under local or regional anesthesia (involving some sedation) and does not require an overnight hospital stay. Many people require surgery on both hands.
• Open release surgery is the traditional procedure used to correct carpal tunnel syndrome. It consists of making an incision up to 2 inches in your wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical conditions.
• Endoscopic surgery may allow somewhat faster functional recovery and less postoperative discomfort than traditional open release surgery but it may also have a higher risk of complications and the need for additional surgery. The surgeon makes one or two incisions (about ½ inch each) in your wrist and palm, inserts a camera attached to a tube, observes the nerve, ligament, and tendons on a monitor, and cuts the carpal ligament (the tissue that holds joints together) with a small knife that is inserted through the tube. Following the surgery, the ligaments usually grow back together and allow more space than before. Your symptoms may be relieved immediately after surgery, but full recovery can take months. You may have infections, nerve damage, stiffness, and pain at the scar. Almost always there is a decrease in grip strength, which improves over time. You may need to modify work activity for several weeks following surgery or need to adjust job duties or even change jobs after recovery from surgery.   

Recurrence of carpal tunnel syndrome following treatment is rare. Less than half of individuals report their hand(s) feeling completely normal following surgery. Some residual numbness or weakness is common.

How can self-care or lifestyle changes support a treatment plan for carpal tunnel syndrome?

At night, keep your wrist straight while resting or asleep to prevent pressing on the nerve and carpal tunnel.

Tasks at home or work, along with workstations, tools, and tool handles, can be redesigned to help your wrist maintain a natural position during work.  Wearing fingerless gloves can help keep hands warm and flexible.  At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, and use correct posture and wrist position.   Jobs can be rotated among workers.  Employers can develop ergonomic programs to adapt workplace conditions and job demands to the capabilities of workers. 

What are the latest updates on carpal tunnel syndrome?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge of the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.  The NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world. NINDS is the leading NIH funding Institute on nerve disorders, including carpal tunnel syndrome.

Scientists supported by NINDS are studying the factors that lead to long-lasting neuropathies (diseases or malfunction of nerves), and how the affected nerves are related to symptoms of pain, numbness, and functional loss. Researchers also are examining biomechanical stresses that contribute to the nerve damage responsible for symptoms of carpal tunnel syndrome in order to better understand, treat, and prevent CTS and other costly and disabling occupational illnesses.

Scientists funded through NIH’s National Center for Complementary and Integrative Health are investigating the effects of acupuncture on pain, loss of median nerve function, and changes in the brain associated with CTS. In addition, a randomized clinical trial designed to evaluate the effectiveness of osteopathic manipulative treatment in conjunction with standard medical care is underway. Evaluations of these therapies and other therapies will help to tailor individual treatment programs.

Another NIH component, the National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS), supports research on tissue damage associated with repetitive motion disorders, including CTS. Scientists have developed animal models that are helping to understand and characterize connective tissue in hopes of reducing harmful tissue buildup and identifying new treatments.

More information about carpal tunnel syndrome research supported by NINDS and other NIH Institutes and Centers can be found using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.  RePORTER also includes links to publications and resources from these projects.

For research articles and summaries on carpal tunnel syndrome, search PubMed, which contains citations from medical journals and other sites.

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Learn About Clinical Trials

Clinical trials are studies that allow us to learn more about disorders and improve care. They can help connect patients with new and upcoming treatment options.

How can I or my loved one help improve care for someone with carpal tunnel syndrome?

Consider participating in a clinical trial so clinicians and scientists can learn more about carpal tunnel syndrome. Clinical research uses human volunteers to help researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.

All types of volunteers are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.

For information about participating in clinical research visit NIH Clinical Research Trials and You. Learn about clinical trials currently looking for people with CTS at Clinicaltrials.gov.
 

Where can I find more information about carpal tunnel syndrome?

The following resources may help individuals, families, friends, and caregivers of people living with CTS:

Foundation for Peripheral Neuropathy
Phone: 877-883-9942

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Phone: 301-496-8190 or 877-226-4267

Information about CTS is also available: 

Centers for Disease Control and Prevention (CDC)
Phone: 800-311-3435 or 404-639-3311

National Library of Medicine
Phone: 301-496-6308 or 888-346-3656

Occupational Safety & Health Administration (OSHA)
Phone: 800-321-6742

Learn about related topics

• Repetitive Motion Disorders 

Carpal Tunnel Syndrome – Symptoms and Treatment – OrthoInfo

Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand and forearm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist. 

In most patients, carpal tunnel syndrome gets worse over time. If untreated for too long, it can lead to permanent dysfunction of the hand, including loss of sensation in the fingers and weakness. For this reason, it is important to diagnose and treat carpal tunnel syndrome promptly.

Early symptoms can often be relieved with simple measures like:

• Wearing a wrist splint while sleeping
• Exercises to keep the nerve mobile
• Avoiding certain activities that aggravate your symptoms
• A steroid injection into the carpal tunnel

If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.

The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and sides of the tunnel are formed by small wrist bones called carpal bones.

The carpal tunnel contains the median nerve and flexor tendons that bend the fingers and thumb.

Reproduced and adapted from Rodner C, Raissis A, Akelman E: Carpal tunnel syndrome. Orthopaedic Knowledge Online Journal. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2009; 7(5). Accessed March 2016.

The roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament. Because these boundaries are very rigid, the carpal tunnel has little capacity to stretch or increase in size.

The median nerve is one of the main nerves in the hand. It originates as a group of nerve roots in the neck; these roots then come together to form a single nerve in the arm.

The median nerve travels down the upper arm, across the elbow, and into the forearm, then passes through the carpal tunnel at the wrist on its way to the hand and fingers. It separates into several smaller nerves along the way, particularly once it reaches the palm. These nerves allow for feeling in the thumb, index finger, middle finger, and half of the ring finger (the thumb side).

The median nerve also controls the muscles around the base of the thumb.

The nine tendons that bend the fingers and thumb also travel through the carpal tunnel with the nerve. These tendons are called flexor tendons because they flex the fingers and thumb.

Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when the tissue surrounding the flexor tendons (known as synovium) swells, putting pressure on the median nerve and reducing its blood supply.  

This abnormal pressure on the nerve can result in numbness, tingling, pain, and weakness in the hand.

Carpal tunnel syndrome is caused by pressure on the median nerve as it travels through the carpal tunnel.

Watch: Carpal Tunnel Syndrome Animation

Most cases of carpal tunnel syndrome are caused by a combination of factors. Studies show that women and older people are more likely to develop the condition.

Other risk factors for carpal tunnel syndrome include:

• Heredity. This is likely an important factor. The carpal tunnel may be naturally smaller in some people, or there may be anatomic differences that change the amount of space for the nerve — and these traits can run in families.
• Repetitive hand use. Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
• Hand and wrist position. Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve.
• Pregnancy. Hormonal changes during pregnancy can cause swelling that results in pressure on the nerve.
• Health conditions. Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.

Symptoms of carpal tunnel syndrome may include:

• Numbness, tingling, burning, and pain — primarily in the thumb and index, middle, and ring fingers. This often wakes people up at night.
• Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
• Pain or tingling that may travel up the forearm toward the shoulder
• Weakness and clumsiness in the hand — this may make it difficult to perform fine movements such as buttoning your clothes
• Dropping things — due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)

In most cases, the symptoms of carpal tunnel syndrome begin gradually, without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.

Nighttime symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken you from sleep. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.

Many patients find that moving or shaking their hands helps relieve their symptoms.

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Physical Examination

During your evaluation, your doctor will talk to you about your general health and medical history and will ask about your symptoms.

They will carefully examine your hand and wrist and perform a number of physical tests. During these tests, your doctor may:

• Press down or tap along the median nerve on the palm side of your wrist and hand to see if it causes any tingling into your fingers (Tinel’s sign).
• Bend and hold your wrists in a flexed position to test for numbness or tingling in your hands.
• Test sensitivity in your fingertips and hands by lightly touching them with a special instrument while your eyes are closed.
• Check for weakness in the muscles around the base of your thumb.
• Look for atrophy in the muscles around the base of your thumb. In severe cases, these muscles may become visibly smaller.

To perform Tinel’s test for nerve damage, your doctor will tap on the inside of your wrist over the median nerve.

Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Tests

Electrophysiological tests. Your doctor may order electrophysiological testing of your nerves to measure how well your median nerve is working and help determine whether there is too much pressure on the nerve. 

These tests will also help your doctor determine:

• The severity of your carpal tunnel syndrome
• Whether the nerve is compressed in other locations
• Whether other nerves are affected
• Whether you have a medical condition (e. g., neuropathy) affecting your nerves in addition to carpal tunnel syndrome

Close up of an EMG being performed with a nerve conduction study.

Electrophysiological tests may include:

• Nerve conduction studies (NCS). These tests measure the signals travelling in the nerves of your hand and arm and can detect when a nerve is not conducting its signal effectively. Nerve conduction studies can help your doctor determine how severe your problem is and help to guide treatment.
• Electromyogram (EMG). An EMG measures the electrical activity in muscles. EMG results can show whether you have any nerve or muscle damage.

Ultrasound. An ultrasound uses high-frequency sound waves to help create pictures of bone and tissue. Your doctor may recommend an ultrasound of your wrist to evaluate the median nerve for signs of compression.

X-rays. X-rays provide images of dense structures, such as bone. If you have limited wrist motion or wrist pain, your doctor may order X-rays to exclude other causes for your symptoms, such as arthritis, ligament injury, or a fracture.

Magnetic resonance imaging (MRI) scans. MRI scans provide better images of the body’s soft tissues than X-rays. Your doctor may order an MRI to help determine other causes for your symptoms or to look for abnormal tissues that could be impacting the median nerve. An MRI can also help your doctor determine if there are problems with the nerve itself, such as a tumor or scarring from an injury.

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Although it is a gradual process, for most people carpal tunnel syndrome will worsen over time without some form of treatment. For this reason, it is important to be evaluated and diagnosed by your doctor early on. In the early stages, it may be possible to slow or stop the progression of the disease.

Nonsurgical Treatment

If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved without surgery. If your diagnosis is uncertain or if your symptoms are mild, your doctor will recommend nonsurgical treatment first.

Wearing a splint or brace reduces pressure on the median nerve by keeping your wrist straight.

Thinkstock © 2016.

Nonsurgical treatments may include:

Bracing or splinting. Wearing a brace or splint at night will keep you from bending your wrist while you sleep. Keeping your wrist in a straight or neutral position reduces pressure on the nerve in the carpal tunnel. It may also help to wear a splint during the day when doing activities that aggravate your symptoms.

Nonsteroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory medications such as ibuprofen and naproxen can help relieve pain and inflammation.

Activity changes. Symptoms often occur when your hand and wrist are in the same position for too long — particularly when your wrist is flexed or extended.

If your job or recreational activities aggravate your symptoms, changing or modifying these activities can help slow or stop progression of the disease. In some cases, this may involve making changes to your work site or workstation.

A steroid injection into the carpal tunnel may relieve symptoms for a period of time.

Nerve gliding exercises. Some patients may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel. Specific exercises may be recommended by your doctor or therapist.

Steroid injections. Corticosteroid, or cortisone, is a powerful anti-inflammatory agent that can be injected into the carpal tunnel. These injections often relieve painful symptoms or help to calm a flare-up of symptoms.

• In patients with mild, early disease, injections may relieve symptoms in the long-term.
• In those with moderate to severe disease, the positive effects of the injection may be temporary.

A cortisone injection may also be used by your doctor to help diagnose your carpal tunnel syndrome.  

Surgical Treatment

If nonsurgical treatment does not relieve your symptoms or provides only temporary relief, your doctor may recommend surgery.

The decision of whether to recommend surgery is based on:

• The severity of your symptoms
• Physical exam findings
• Response to non-operative treatment
• Results of testing

In long-standing cases with constant numbness and wasting of your thumb muscles, surgery may be recommended to prevent irreversible damage. Surgery may also be recommended if you do not get relief with non-operative treatments and/or demonstrate significant nerve changes on testing.

Surgical Procedure

The surgical procedure performed for carpal tunnel syndrome is called a carpal tunnel release.

Most surgeons perform this procedure using one of two different surgical techniques, but the goal of both is to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel (transverse carpal ligament). Release of this ligament increases the size of the tunnel and decreases pressure on the median nerve, allowing for appropriate blood flow to the nerve and function of the nerve.

The transverse carpal ligament is cut during carpal tunnel release surgery. When the ligament heals, there is more room for the nerve and tendons.

In most cases, carpal tunnel surgery is done on an outpatient basis. The surgery can be done under general anesthesia, which puts you to sleep, or under local anesthesia, which numbs just your hand and arm. In some cases where local anesthesia is used, you will also be given a light sedative through an intravenous (IV) line inserted into a vein in your arm.

Open carpal tunnel release. In an open carpal tunnel release surgery, your doctor makes a small incision in the palm of your hand and views the inside of your hand and wrist through this incision. During the procedure, your doctor will divide the transverse carpal ligament (the roof of the carpal tunnel). This increases the size of the tunnel and decreases pressure on the median nerve.

After surgery, the ligament may gradually grow back together in a lengthened fashion, but there will be more space in the carpal tunnel, and pressure on the median nerve will be relieved.

Endoscopic carpal tunnel release. In endoscopic surgery, your doctor makes one or two smaller skin incisions (called portals) and uses a miniature camera, or endoscope, to see inside your hand and wrist. A special knife is used to divide the transverse carpal ligament, similar to the open carpal tunnel release procedure.

Here, an endoscope is inserted through a portal in the patient’s wrist. A cutting instrument will be inserted in the palm.

The outcomes of open surgery and endoscopic surgery are similar. There are benefits and potential risks associated with both techniques. Your doctor will talk with you about which surgical technique is best for you.

Recovery

Immediately after surgery, you will be encouraged to elevate your hand above your heart and move your fingers to reduce swelling and prevent stiffness.

You should expect some pain, swelling, and stiffness after your procedure. Minor soreness in your palm may last several weeks to several months.

Nighttime symptoms improve dramatically for most patients in the first week or so after surgery.

Grip and pinch strength

• Grip and pinch strength usually return by about 2 to 3 months after surgery.
• If the condition of your median nerve was poor before surgery, grip and pinch strength may not improve for about 6 to 12 months.
• In very severe cases, the normal strength you had before you developed carpal tunnel syndrome may not completely return. However, surgery is still important in these cases to prevent worsening of the condition and function of your nerve.

Numbness and tingling

• Numbness and tingling tend to improve over the first several months after surgery.
• Some patients with mild disease may experience return of sensation right away.
• Patients with severe disease may not have normal sensation in their fingertips for 6 to 12 months after surgery.
• In very severe cases, some patients may never completely regain normal sensation. Again, surgery is still important in these cases to prevent the condition from getting worse.

You may have to wear a splint or wrist brace for several weeks after surgery. You will be allowed to use your hand for light activities, taking care to avoid significant discomfort. Driving, self-care activities, and light lifting and gripping may be permitted soon after surgery.

Your doctor will talk with you about when you will be able to return to work and whether you will have any restrictions on your work activities.

Complications

Although complications are possible with any surgery, your doctor and surgical team will take steps to minimize the risks. The most common complications of carpal tunnel release surgery include:

• Bleeding
• Infection
• Wound healing issues
• Nerve aggravation or injury

Outcomes

For most patients, surgery will improve the symptoms of carpal tunnel syndrome. Recovery, however, may be gradual, and complete recovery may take up to a year.

If you have significant pain and weakness for more than 2 months, your doctor may refer you to a hand therapist who can help you maximize your recovery.

If you have another condition that causes pain or stiffness in your hand or wrist, such as arthritis or tendinitis, it may slow your overall recovery. In long-standing cases of carpal tunnel syndrome with severe loss of feeling and/or muscle wasting around the base of the thumb, recovery will also be slower. For these patients, a complete recovery may not be possible.

Occasionally, carpal tunnel syndrome can recur, although this is rare. If this happens, you may need additional treatment or surgery.

To assist doctors in the management of carpal tunnel syndrome, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Plain Language Summary – Clinical Practice Guideline – Carpal Tunnel Syndrome – AAOS

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Signs, symptoms and treatment of carpal tunnel syndrome

Carpal tunnel syndrome or carpal tunnel syndrome occurs when tissues in the carpal tunnel become inflamed and put pressure on the median nerve. This can cause pain in the arm and a feeling of numbness. Some people have a narrow carpal tunnel, which increases the risk of developing carpal tunnel syndrome.

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Causes of carpal tunnel syndrome

Some factors that can lead to swelling of the carpal tunnel include:

• Repetitive monotonous movements of the wrist.

• Intense wrist movements.

• Masses (such as tumors or cysts) in the wrist that put pressure on the median nerve.

• Wrist injuries (such as dislocation, sprain, or fracture).

• Lack of vitamin B6 in the diet.

• Use of aromatase inhibitors (drugs used to treat breast cancer), which can cause joint pain.

• Familial predisposition to carpal tunnel syndrome.

Associated diseases such as:

• Arthritis (inflammation and stiffness of the joints).

• Renal failure (impaired kidney function).

• Liver diseases.

• Hypothyroidism (decreased thyroid function).

• Obesity (excessive accumulation of fat in the body).

• Amyloidosis (accumulation of protein deposits in organs).

• Acromegaly (unusual enlargement of the bones).

Symptoms of Carpal Tunnel Syndrome

Symptoms of carpal tunnel syndrome can appear in the wrists, palms, and fingers. Common symptoms are:

• Pain.

• Burning.

• Numbness and tingling, often in the thumb, index and middle fingers.

• Weakness.

• Impossibility of clenching the fist.

• Stiffness.

• Diagnosis of carpal tunnel syndrome

To determine if you have carpal tunnel syndrome, your doctor may:

• Review your health history.

• Conduct a medical examination.

• If necessary, order tests that evaluate the function of muscles and nerves. These tests include neuromuscular conduction and electromyography.

• Your doctor may also do blood tests and x-rays to rule out other possible causes of pain and swelling.

Treatment of carpal tunnel syndrome

There are treatments that can help relieve the symptoms of carpal tunnel syndrome. The time required for improvement or complete disappearance of symptoms is individual for each patient.

The main goal of treatment is to relieve pressure on the median nerve to improve the condition of the hand. Another goal is to identify the cause of carpal tunnel syndrome.

Methods of treatment

The type of treatment that will be given depends on the duration and severity of the symptoms. Discuss with your doctor which treatments are right for you.

Depending on your symptoms, your doctor may suggest the following:

Giving rest to the wrist. Rest will help relieve pressure on the median nerve. It is also helpful to avoid or modify wrist movements that worsen symptoms.

Using a wrist splint. A wrist splint is a supportive device that protects the hand and wrist and prevents them from moving. The splint keeps the wrist in a neutral position (not bent up or down), reducing pressure on the median nerve. Your doctor will tell you how to properly use a wrist splint.

Cooperation with a physiotherapist or occupational therapist. Your PCP may suggest that you work with a physical or occupational therapist who:

• Gives you advice on changing habits that can cause stress.

• It will help you put the splint on your wrist correctly. They will also teach you the correct hand movements and position to avoid pressing on the median nerve.

• Suggest exercises to help strengthen your hand and wrist as you recover.

If these treatments do not provide relief, your healthcare provider may suggest:

• Introduction of steroid injections into the carpal tunnel. If the pain does not subside after other treatments, steroid injections may help relieve pain and swelling for several weeks or months.

• Operation on the carpal canal. Surgery may be recommended if other treatments have failed. The goal of surgery is to relieve pressure on the median nerve and reduce pain. Most people recover after surgery and prevent symptoms from recurring.

What is carpal tunnel syndrome?

Carpal tunnel syndrome (also called carpal tunnel syndrome) occurs when the narrow passage between the bones and ligaments in the wrist narrows. This narrowing puts pressure on the nerve, causing numbness and tingling in the thumb.

Carpal tunnel syndrome can occur in people who spend a lot of time on the computer or playing video games. In fact, these activities may be the cause of carpal tunnel syndrome.

What causes carpal tunnel syndrome?

There is little space inside the carpal tunnel. It contains nine tendons and one nerve. If something takes up extra space in the canal, the nerve is compressed, which causes numbness and tingling in the area of ​​the wrist where the nerve functions. Swelling can occur when a person repeats the same type of movement, such as typing on a computer, playing a musical instrument, or playing video games for a long time. This swelling can compress the nerve.

Other activities that can cause nerve compression include gymnastics, especially handstands, and racquet sports such as tennis.

Carpal tunnel syndrome can also result from fractures or dislocations of the bones in the wrist, or sprains that cause swelling around the carpal tunnel.

Who is affected by carpal tunnel syndrome?

Carpal tunnel syndrome usually develops in adults, but in rare cases it can occur in children. Most people with carpal tunnel syndrome are over the age of 30, and women are more susceptible to this syndrome than men. People with certain medical problems, such as arthritis, thyroid problems, and diabetes, are also at risk of developing carpal tunnel syndrome. Pregnant women and overweight individuals are also more likely to experience this syndrome.

How is carpal tunnel syndrome diagnosed and treated?

To determine the presence of carpal tunnel syndrome, doctors ask questions about the condition of the patient’s hand and conduct an examination.

Bandages or splints may help patients with mild carpal tunnel syndrome. They are usually worn at night and prevent wrist flexion. The correct position of the wrist, without flexion, allows you to increase the space in the carpal tunnel for the nerve. Resting your wrist will help reduce tendon swelling. You can also use anti-inflammatory drugs to reduce swelling.

Sometimes a doctor may use a cortisone medication to reduce inflammation and swelling in the carpal tunnel. This drug is injected into the canal by injection. As the condition improves, a doctor may recommend specific wrist exercises and correct hand positioning for daily activities such as typing.

If none of these treatments provide relief, surgery may be needed to relieve pressure on the median nerve. This operation is quick and most patients can be discharged home the same day. Most people recover completely and prevent symptoms from recurring.

How can carpal tunnel syndrome be prevented?

Although children rarely suffer from carpal tunnel syndrome, it is helpful to form healthy habits today that will help prevent this problem in the future. When you spend a lot of time at the computer or writing, be sure to take breaks and don’t overwork yourself. Regular pauses and active movements will help prevent overexertion. You can also set a timer to remind you of breaks every hour.

Make sure your workspace is comfortable and ergonomic, especially if you work at a computer. Use a chair that can be adjusted in height to maintain proper body position. Hands and wrists should be level with the keyboard and monitor. Observe the following rules:

• Keep your elbows close to your body and your wrists straight, do not bend them up or down.

• If you are using a wrist pad, do not apply strong pressure to it when typing.

• Keep items you use frequently within easy reach.

By following these guidelines, you will be able to take proper care of your wrists and keep them in good condition.

Tunnel neuropathy

Tunnel neuropathies are damage to peripheral nerves due to their compression in anatomical narrowings (tunnels): rigid bone-fibrous and fibromuscular canals, aponeurotic fissures and holes in ligaments. The main predisposing factor in the development of tunnel neuropathy is the narrowness of one or another anatomical tunnel through which the nerves pass.

Causes

In recent years, evidence has accumulated that indicates that narrow anatomical canals can be a genetically determined factor that is transmitted from generation to generation. Another reason that can lead to the development of carpal tunnel syndrome is the presence of congenital malformations in the form of additional fibrous cords, muscles and tendons, and rudimentary bone spurs.

However, only predisposing factors are usually not enough for the development of this disease. Tunnel syndrome makes itself felt when contributing factors come into play. And these can be some diseases (diabetes mellitus, acromegaly, hypothyroidism, etc.), professional, household and sports loads on a certain muscle group. Constant microtraumatization of the neurovascular bundle in the narrow canal contributes to the development of aseptic inflammation, leading to local edema of fatty tissue. Edema, in turn, contributes to even greater compression of the anatomical structures. Thus, the vicious circle closes, and this leads to the progression and chronization of the process.

Symptoms

The main symptom of tunnel neuropathy is pain. The pains can be shooting, paroxysmal in nature, similar to an electric shock, or they can have a constant aching character, take on a burning hue, be accompanied by dysesthesias (disturbances in sensitivity) in the innervation zone of the affected nerve. With the infringement of the nerves that take part in the innervation of the muscles, it is possible to reduce strength, fatigue and even muscle atrophy. With compression of the arteries and veins, the development of vascular disorders is possible, which is manifested by blanching, a decrease in local temperature, or the appearance of cyanosis and swelling of a part of the limb.

The treatment of tunnel neuropathies consists in decompression (pressure reduction) of the contents of the anatomical canal. As a result, blood circulation improves, and the myelin sheath of the damaged nerve is regenerated. With proper timely treatment, a full recovery is possible. The therapy consists in a protective mode, the introduction of a suspension of steroids into an anatomically narrowed canal. In more severe cases, decompression of nerve structures requires surgical treatment – a dissection of the fibrous canal is performed, and a revision of the nerve is carried out. The operation is not dangerous and effective, in most cases leading to a complete restoration of the function of the damaged nerve, pain relief.

Carpal tunnel syndrome

Carpal tunnel syndrome is the most common form of tunnel neuropathy. The development of this disease is due to compression of the median nerve in the wrist area, in the place where it passes through a narrow rigid tunnel formed by the carpal bones and carpal ligament.

Together with the median nerve, 9 tendons pass through this canal, which takes part in the flexion of the fingers. Most cases of carpal tunnel syndrome are due to fluid accumulation and an increase in the volume of the synovial sheaths surrounding these tendons (tenosynovitis or tendovaginitis). The severity of the symptoms of this disease can range from barely noticeable to severe forms. Without treatment, the course of the disease tends to progress.

Who suffers from carpal tunnel syndrome

Most often, carpal tunnel syndrome occurs in women over 30 years of age. The most common cause of the disease is nonspecific inflammation of the synovial bags surrounding the flexor tendons of the fingers (tenosynovitis). Carpal tunnel syndrome is often found in persons whose work is associated with frequent rhythmic flexion of the fingers (milkmaids), with the use of vibrating tools (perforators, jackhammers). Many diseases, certain medications, hand trauma, and even pregnancy can cause the volume of fluid in the synovial sheaths to increase to such an extent that it compresses the median nerve in the rigid canal. The median nerve provides sensory innervation to most of the palm and fingers. In addition, this nerve innervates some muscles in the hand area.

Symptoms

The most common complaint in this disease is a decrease in the sensitivity of any of the five fingers of the hand, with the exception of the little finger. Patients often complain that they cannot hold things in the affected hand due to numbness. Violation of sensitivity is accompanied by pain radiating to the forearm. These symptoms often appear or worsen at night, because at this time the outflow of fluid from the vessels of the limb slows down, which can lead to its accumulation in the synovial sheaths. In addition, during sleep, involuntary flexion of the hand may occur, which can also increase nerve compression. In severe cases, there is atrophy and weakness in the muscles of the eminence of the thumb. Stiffness in the fingers occurs in 25% of patients suffering from carpal tunnel syndrome and is apparently due to the presence of concomitant tendovaginitis.

Diagnostics

The diagnosis can be established in most cases with careful questioning and physical examination. Often, symptoms appear or worsen 60 seconds after a strong clenching of the hand into a fist (Phalen’s symptom) or when tapping with a neurological hammer on the wrist at the passage of the median nerve (Tinel’s symptom). In diagnostically difficult situations, a more painful (and expensive) study of impulse conduction along the nerve (stimulation electromyography) is used.

Treatment

In patients with a mild course of the disease, in whom symptoms have appeared recently or are not permanently expressed, conservative therapy is successfully used, which consists in taking anti-inflammatory drugs and fixing the hand with a splint bandage for the night.