Carpal tunnel syndrome

Overview

The carpal tunnel is a narrow passage in the wrist. The median nerve and finger tendons run through it. When the tissues in the tunnel swell, they press on the nerve.

Symptoms usually start slowly, often in the hand you use most. Without treatment, the nerve can be damaged, causing lasting numbness and a weak thumb. Early treatment helps prevent this.

Symptoms

Symptoms usually start slowly and get worse over time.

• Numb or tingling fingers, mostly the thumb, index, and middle fingers
• Symptoms that wake you at night
• Needing to shake out your hand
• Weak grip or dropping things

Less common

• Pain in the wrist or hand that may spread up the arm
• Fingers that feel swollen but aren't
• Trouble with buttons or small objects
• A thin, weak muscle at the base of the thumb

How it usually goes

• Early: Tingling and numbness, mostly at night.
• Later: Symptoms during the day, with driving or holding a phone.
• Without treatment: Weakness and lasting numbness can develop.

When to get medical care

Causes

Carpal tunnel syndrome happens when swelling in the wrist squeezes the median nerve. Often no single cause is found.

Repeated hand and wrist movements, vibrating tools, wrist injuries, pregnancy, diabetes, thyroid problems, and arthritis can all play a part.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.

Who is more likely to get it

• Women are more likely to get it
• Jobs or hobbies with repeated wrist motion or vibrating tools
• Pregnancy
• Diabetes, thyroid disease, or rheumatoid arthritis

Possible complications

• Rheumatoid arthritis: Can cause swelling that squeezes the nerve
• Underactive thyroid: Linked with carpal tunnel

Diagnosis

A healthcare professional asks about your symptoms and tests your hand.

Questions you may be asked

• Which fingers are numb or tingling
• Whether symptoms wake you up at night
• Work or hobbies that use your hands a lot
• Diabetes, thyroid problems, arthritis, or pregnancy
• Neck pain

The exam

They'll test feeling and strength in your fingers. They may tap on your wrist or have you bend your wrists to see if it brings on tingling.

Tests

If the diagnosis isn't clear or surgery is being considered:

• Nerve tests: Nerve conduction studies and EMG check how well the nerve and muscles work.
• Blood tests or X-ray: To look for diabetes, thyroid problems, arthritis, or a fracture.

Treatment

Treatment starts with simple steps. Most people try these before surgery.

Self-care

• Wear a wrist splint at night to keep your wrist straight
• Take breaks from tasks that bend your wrist or use tools that vibrate
• Keep wrists straight when typing; set your keyboard low
• Don't sleep on your hands or with wrists bent
• Use cool packs if the wrist is swollen
• Ask about hand exercises or yoga, which may ease pain and help grip

Medicines

Medicines may ease symptoms for a short time.

A steroid shot in the wrist may help for a while. If symptoms are severe or don't improve, surgery to cut the ligament over the tunnel takes pressure off the nerve. Full recovery can take months.

How it compares

Prevention

You can lower the strain on your wrists:

• Keep wrists straight when typing or using tools
• Take regular breaks and stretch your hands
• Use a lighter grip
• Keep your hands warm

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a neurologist (brain and nerve doctor).

Children, pregnancy, and older adults

• Pregnancy: Carpal tunnel is common in pregnancy from fluid buildup and often gets better after birth. A night splint can help.
• Diabetes: Nerve problems are more common. Tell your healthcare professional about numbness.
• Workers: An occupational therapist can suggest changes to your workspace.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

Many people improve with a splint and changes in activity. Some need surgery, which usually works well, though some numbness can remain.

Myths and facts

Getting ready for your visit

Note when symptoms happen.

What to bring

• Which fingers are affected
• Activities that bring on symptoms
• Health problems like diabetes or thyroid disease

Questions to ask

• Is this carpal tunnel or a pinched nerve in my neck?
• Should I wear a splint, and when?
• Do I need nerve tests?
• When should I think about surgery?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Carpal tunnel syndrome