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Carpal tunnel syndrome

Everyone is talking about it. Lots of people wonder if they have it. What is carpal tunnel syndrome?

The carpal tunnel is formed on three sides by the carpal bones of the wrist. The top of the tunnel is a ligament. It is on the palm side of the wrist. Tendons from the muscles in the forearm pass through the carpal tunnel to the ends of the fingers and thumb. A nerve also passes through the carpal tunnel. The tendons swell up when overworked or irritated and push the nerve against the ligament. This nerve, called the median nerve, provides sensations for the thumb, index and middle fingers, and part of the palm of the hand. The nerve also controls some of the muscles that move the thumb.

Symptoms are usually in the thumb, index and middle fingers, and occasionally in the ring finger. There may be symptoms even when not using the hands. The first symptoms usually start at night. They may include:

• burning, numbness or tingling
• difficulty gripping or making a fist
• loss of sense of heat and cold in areas of the hand and fingers
• feeling that hands are swollen when they are not
• pain that goes from the hand up the arm to the shoulder

How does carpal tunnel syndrome happen? Sometimes, it occurs with forceful movements of the hand and wrist that are done over and over again. This can happen at home or at work. Using vibrating tools such as jackhammers may cause symptoms. Some other causes and conditions that may be a factor in carpal tunnel syndrome are:

• repeated bending of the wrist
• broken or out of place bones in the wrist that may cause the swelling
• arthritis
• thyroid problems
• diabetes
• pregnancy and
• being overweight

Although any of these may be present, most of the time the cause is not known. Treatment includes keeping the wrist from moving by using a special splint to lessen pressure on the nerve. The splint is worn at night as well as when using the hand and wrist. Non-steroidal anti- inflammatory (NSAIDs) medicines such as aspirin or ibuprofen may be used. Aspirin or medicines that have aspirin in them should not be given to anyone younger than 18 years of age. Taking aspirin is a risk for a serious illness called Reye's syndrome. NSAIDs should be taken with food or milk to prevent stomach upset. NSAIDs should not be taken by anyone who has been diagnosed with asthma, ulcer disease, or a bleeding disorder. Taking NSAIDs increases the risk of bleeding with trauma, dental work, surgery, or if taking blood thinners (anticoagulants).

People with a severe case of carpal tunnel syndrome may need to have an injection of cortisone into the carpal tunnel. This helps to reduce the swelling. Any of these treatments work best when used early when carpal tunnel syndrome is just starting. For a very few people, surgery may be necessary to cut the ligament and relieve the pressure on the nerve.

Following surgery most people recover completely. It is important to avoid injury of the carpal tunnel again. The best way to do this is by changing the way repeated movements are done. Movements can be done less often, or with longer rest periods between movements. It may help to change the way the movements are done. Other preventions include:

• stretch and flex hands, fingers, and arms often
• alternate tasks
• change or modify the activities being done and
• change the work environment

Last Reviewed 2005

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIL File BONE4233.RF2 VRS# 4233 Data Version 7.0 Copyright 1999, 2002-2003 McKesson Health Solutions LLC. All rights reserved.