What is carpal tunnel syndrome?

Carpal tunnel syndrome is pain, weakness, tingling, and numbing in the thumb and fingers. It is caused by pressure on the median nerve as it passes through an area of the wrist called the carpal tunnel.

The carpal tunnel is located on the palm side of the wrist. It is a narrow passageway formed by the carpal bones and the ligament that holds the bones in position. It forms a tunnel-like space.

The median nerve and the tendons that bend and flex your fingers pass through the carpal tunnel. When this area is compressed by swelling due to overuse or injury, the nerves that lead to the thumb and three middle fingers become irritated.

Symptoms

Common symptoms of carpal tunnel syndrome include:

  • Dull ache or pain in the hand, forearm, or upper arm
  • A feeling of “pins and needles” in the fingers, specifically the thumb, index, and middle fingers
  • Pain and/or numbness that worsen at night and even interrupt sleep
  • Weakness when gripping objects
  • Swelling in the fingers
  • Tingling or burning in the fingers

Causes

The cause of carpal tunnel syndrome is not always known. Things that may contribute include:

  • Small repetitive hand movements, like typing, or playing an instrument
  • Sleeping with a bent wrist or doing activities where the wrist is bent back for long periods
  • Joint or bone diseases, such as arthritis
  • Other medical conditions, such as diabetes or prediabetes
  • Injuries of the wrist that cause swelling and inflammation, such as sprains, breaks, or dislocations
  • A family history of carpal tunnel syndrome

Diagnosis and Tests

Your healthcare provider will check your medical history and look at your wrist and hand. You may be asked to move your hand and wrist in a certain way. Your provider may touch your fingertips and hand to check for sensation and weakness.

Other tests may be recommended to check the electrical signals in your nerve. These tests can tell your healthcare provider if you have carpal tunnel syndrome or if you have any nerve damage.

Nerve conduction study

This test shows whether or not the median nerve is working as it should. This helps your provider know the severity of your problem.

Electromyography (EMG)

This test checks how the muscles in your wrist, hand, and arm react when the median nerve is stimulated. It can show your provider whether or not you have nerve damage.

Surgical Treatment Options

Carpal tunnel surgery is usually performed by a surgeon who specializes in treating the bones and tissues of the hands. During surgery, the ligament that surrounds the bones in the carpal tunnel (the transverse carpal tunnel ligament) is cut. This reduces pressure on the median nerve. This may be done in one of two ways:
  • During open surgery, an incision is made in the skin of your palm to reveal the transverse carpal ligament and other tissues. The surgeon cuts the ligament and closes the wound. Open surgery leaves a bigger scar, and may require a longer recovery. 
  • During endoscopic surgery, one or two small incisions are made near the wrist. A tiny camera (an endoscope) is inserted and displays images of the inside of your wrist on a monitor. The transverse carpal ligament is cut from underneath. Endoscopic surgery may have faster recovery.

    • Either of these surgeries may be performed in the operating room or in the office with local anesthesia.

Non-surgical Treatment Options

Nonsurgical treatment of carpal tunnel syndrome includes:

  • Taking frequent breaks and resting the hands
  • Avoiding the activities that seem to make the symptoms worse
  • Using cold packs to reduce swelling
  • Using splints to hold your wrists still while your sleep
  • Taking nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen, naproxen, or aspirin
  • Doing exercises or physical therapy
  • Getting a cortisone injection to relieve pain

Prevention

Preventing carpal tunnel syndrome takes time and effort. You may need to change something you do at work, in your home, or during a sport or hobby.

Some of the preventive care tips include:

  • Exercising your finger and hand muscles to maintain their strength and flexibility
  • Switching hands or resting during repetitive motion activities
  • Stopping activities that cause numbness or pain in your fingers, hand, or wrist
  • Using a splint to hold your wrist in a neutral position, in order to reduce stress on the fingers, hand or wrist
  • Maintaining overall good health, including staying a healthy weight, not smoking, and getting regular exercise
  • Improving your posture

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