Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

The carpal tunnel is a small tunnel in your wrist. It is filled with ligaments, blood vessels and the median nerve. Your median nerve is located between the flexor tendons and carpal ligament in your wrist. When ligaments in the carpal tunnel become over-worked and swollen, pressure is put on the median nerve. This pressure and swelling is called carpal tunnel syndrome (CTS). You may get carpal tunnel syndrome in one or both of your wrists.

What causes carpal tunnel syndrome?

Jobs that require forceful wrist movement, or jobs where you need to move your wrist a certain way can cause CTS. These jobs include typing and factory line work. This kind of wrist movement increases pressure on the median nerve, and can cause CTS. The following place you at a higher risk of having CTS:

• Being pregnant.
  
  
• Conditions such as diabetes, arthritis, and hypothyroidism.
  
  
• Drinking too much alcohol, too often.
  
  
• Having injured your wrist in the past.
  
  
• Obesity (weighing more than what is suggested by your caregiver).

What are the signs and symptoms of carpal tunnel syndrome?

Your signs and symptoms may come and go. You may have one or more of the following signs and symptoms:

• Pain, numbness, tingling, or a burning feeling in your hand. This is most often felt in the thumb, first finger, and middle fingers. Pain may be felt as high up as your shoulder. Your pain may be a dull ache, or it may be sharp and shooting. Keeping your wrist in one position while driving a car may be painful.
  
  
• Hand weakness that makes it hard to do every day tasks such as writing or holding a book. You may have trouble buttoning your shirt, or tying your shoes. Your hand grip may be weak, causing you to drop things.
  
  
• Hand swelling that makes your jewelry, such as rings, feel tight.

How is carpal tunnel syndrome diagnosed?

You may have one or more of the following tests:

• Nerve compression test: Your caregiver will press on your wrist, and gently move it in different ways. If you feel pain in your median nerve while this is being done, you may have CTS.
  
  
• Local injection of steroids: For this test, you will get three or four injections (shots) of steroid medicine. You will need to tell your caregiver how much and how long your pain is relieved after the shots. Caregivers may use this test as a way to know if you have CTS.

The following tests may be done to help your caregiver learn if you have CTS. These tests can also show caregivers how bad your nerve injury is. Knowing this helps your caregiver decide what treatment may be best for you.

• Electromyography: This is also called an EMG. An EMG is done to test the function of your muscles and the nerves that control them. Electrodes (wires) are placed on the area of muscle being tested. Needles that enter your skin may be attached to the electrodes. The electrical activity of your muscles and nerves is measured by a machine attached to the electrodes. Your muscles are tested at rest and with activity.
  
  
• Nerve conduction study: This test checks how well the nerves control the muscles of your hand.
  
  
• Magnetic resonance imaging: This test may be used to look at the muscles, joints, bones, or blood vessels in your wrist.

How is carpal tunnel syndrome treated?

In some cases, CTS may go away without treatment. In other cases, you may need one or more of the following treatments:

• Wrist splint: This is a brace that looks like a finger-less glove. It keeps your wrist straight or in a slightly bent position. Your caregiver will decide which position is best for you. A wrist splint decreases pressure on the median nerve by letting your wrist rest.
  
  
• Therapy: Physical therapists will show you ways to exercise and strengthen your wrist. Occupational therapists will show you safe ways to use your wrist while doing your usual activities.
  
  
• Transcutaneous electric nerve stimulation: This is also called TENS. This treatment may decrease your wrist pain. Ask your caregiver for more information about TENS.
  
  
• Medicines:
  
  
  • NSAIDs: Nonsteroidal anti-inflammatory (NSAID) medicine may decrease swelling and pain or fever. This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
    
    
  • Diuretics: This medicine helps your body get rid of extra fluid which causes swelling.
    
    
  • Steroids: This medicine may be given to decrease pain and swelling. This medicine can be taken as a pill, or given to you as an injection (shot).
  
  
• Surgery: A carpal tunnel release (decompression) is surgery to take pressure off of the median nerve. Ask your caregiver for more information about carpal tunnel surgery.

What are the risks of having carpal tunnel syndrome?

• Your CTS may get worse over time if it is not treated. The pain, numbness, tingling, or burning may get worse, and last longer. Your hand and wrist may get weaker. You may have lasting nerve damage or paralysis (loss of feeling or movement) of your hand.
  
  
• With steroid injections, your tendon or the median nerve may be injured. You may need to keep getting shots to help you cope with the pain. Medicine used to treat CTS may cause stomach, kidney or liver problems. After surgery, the surgery area may be sore, scars may form, and the area may not heal well. Even after treatment, your pain, numbness, tingling, burning and weakness may not go away, or may come back. You may bleed more than expected during surgery. You may get an infection in your wrist after surgery.

How can I help prevent carpal tunnel syndrome from getting worse?

• After using your wrist a lot, place an ice pack on it. This may reduce swelling in the carpal tunnel.
  
  
• Do exercises. Your caregiver may have you do exercises to help strengthen your wrist and hand. Ask your caregiver for more information about these exercises.
  
  
• Let your hands rest for a short time between repeating movements, such as typing on a keyboard.
  
  
• Stop what you are doing when you feel pain in your wrist. Gently massage your wrist and hand. This may help decrease your pain.
  
  
• Wear your wrist splint. You may need to wear the splint for up to eight weeks.

When should I call my caregiver?

Call your caregiver if:

• You feel that your pain, numbness, tingling, burning or weakness are worse than before.
  
  
• You have questions or concerns about your wrist or hand pain, or treatment.
  
  
• You have questions or concerns about how and when to wear your wrist brace.

When should I seek immediate help?

Seek care immediately or call 911 if:

• Your hand suddenly loses feeling and you cannot move it.
  
  
• Your hand suddenly changes color.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Carpal Tunnel Syndrome