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Carpal tunnel syndrome

Definition

The median nerve gives feeling and movement to the palm side of your hand. This includes the palm side of the thumb, index, finger, middle finger, and ring finger.

The area in your wrist where this nerve enters the hand is called the carpal tunnel. This tunnel is normally narrow. Any swelling can pinch the nerve and cause pain, numbness, tingling, or weakness. This is called carpal tunnel syndrome.

Alternative Names

Median nerve dysfunction; Median nerve entrapment

Causes

Some people who develop carpal tunnel syndrome were born with a small carpal tunnel.

Carpal tunnel syndrome can also be caused by making the same hand and wrist motion over and over. Using hand tools that vibrate may also lead to carpal tunnel.

Studies have not proved that carpal tunnel is caused by typing on a computer, using a mouse, or repeating movements while working, playing a musical instrument, or playing sports. But, these activities may cause pain and swelling of the tendons or bursa.

Carpal tunnel syndrome occurs most often in people ages 30 to 60. It is more common in women than men.

Other factors that may lead to carpal tunnel syndrome include:

Symptoms

Exams and Tests

During a physical exam, your health care provider may find:

Tests that may be ordered include:

Treatment

Your health care provider may suggest the following:

Changes you can make in your workplace to reduce the stress on your wrist include:

MEDICATIONS

Medications used in the treatment of carpal tunnel syndrome include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. Corticosteroid injections given into the carpal tunnel area may relieve symptoms for a period of time.

SURGERY

Carpal tunnel release is a surgical procedure that cuts into the ligament that is pressing on the nerve. Surgery is successful most of the time, but it depends on how long the nerve compression has been occurring and how severe it is.

Outlook (Prognosis)

Symptoms often improve without surgery. But more than half of cases eventually need surgery. Even if surgery is successful, full healing can take months.

If carpal tunnel is not treated, the nerve can be damaged. This damage can cause permanent weakness, numbness, and tingling.

When to Contact a Medical Professional

Call for an appointment with your health care provider if:

Prevention

Use tools and equipment that are properly designed to reduce the risk of wrist injury.

Ergonomic aids, such as split keyboards, keyboard trays, typing pads, and wrist braces, may be used to improve wrist posture during typing. Take frequent breaks when typing and always stop if you feel tingling or pain.

References

Alvero R, Borkan JM, Ferri FF, et al. Carpal tunnel syndrome. In: Ferri's Clinical Advisor. 1st ed. Philadelphia, PA: Elsevier Mosby; 2013.

Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middlekoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments -- a systematic review. Arch Phys Med Rehabil. 2010;91:981-1004.

Huisstede BM, Randsdorp MS, Coert JH, Glerum S, van Middlekoop M, Koes BW. Carpal tunnel syndrome. Part II: effectiveness of surgical treatments -- a systematic review. Arch Phys Med Rehabil. 2010;91:1005-1024.

Keith MW. American Academy of Orthopaedic Surgeons clinical practice guidelines on the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2009;91(10):2478-2479.

Keith MW. American Academy of Orthopaedic Surgeons clinical practice guidelines on the treatment of carpal tunnel syndrome. J Bone Joint Surg Am. 2010;92(1):218-219. 

Thomsen JF, Gerr F, Atroshi I. Carpal tunnel syndrome and the use of computer mouse and keyboard: a systematic review. BMC Musculoskelet Disord. 2008;Oct 6;9:134.

Tosti R, Asif IM. Acute carpal tunnel syndrome. Orthop Clin N Am. 2012;43:459-465.

Wang L. Electrodiagnosis of carpal tunnel syndrome. Phys Med Rehabil Clin N Am. 2013;24:67-77.



Review Date: 5/15/2014
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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