Carpal tunnel syndrome

• weakness in 1 or both hands
• numbness or tingling in the thumb and next 2 or 3 fingers of 1 or both hands
• numbness or tingling of the palm of the hand
• joint pain ( wrist pain ) in 1 or both hands can occur
• impaired fine finger movements in 1 or both hands
• weak grip, difficulty bringing the thumb across the palm to meet the other fingers (thumb opposition)

Signs and Tests:
Physical examination shows decreased sensation in the palm, thumb, index finger, middle finger, and thumb-side (radial surface) of the ring finger. The hand grip is weak. Tapping over the median nerve at the wrist causes numbness (Tinel's sign). Bending the wrist forward all the way (full flexion--called Phalen's test) or bending the wrist back also causes numbness.

Electromyography and nerve conduction velocity may be performed, showing decreased conduction across the wrist. Wrist X-rays may also be recommended.

Treatment:
OVERVIEW:
In some cases, no treatment is necessary. In most cases, however, at least conservative treatment is recommended. This may be as simple as resting and splinting the wrists for a couple of weeks or making other small lifestyle changes. If these methods are not successful in relieving symptoms, or if symptoms are more severe, medications may be recommended. In over 50% of cases, surgery is eventually required to relieve pressure on the nerve.

MEDICATIONS:
Medications used in the treatment of carpal tunnel syndrome include diuretics ("water pills" which can get rid of some of the fluid that accumulates in the wrist tissues) and anti-inflammatory analgesics (NSAIDs). The carpal tunnel may be injected with corticosteroids, and in some cases this provides dramatic relief of symptoms. (Note: It is the carpal tunnel space that is injected, NOT the nerve!)

SURGERY:
Carpal tunnel release is a surgical procedure that cuts into the ligament to relieve pressure on the median nerve. Most of the time relief is almost immediate (upon recovery), and usually the problem does not return.

LIFESTYLE CHANGES:
One of the first treatments suggested and tried consists of resting and splinting the wrists. The hand(s) are rested by placing the wrists in splints at night for 1 to 2 weeks. Sometimes the splints are also used periodically throughout the day when the use of the hands is unnecessary. In some cases, this treatment is satisfactory; however, in most, this only provides temporary relief, or no relief.

Often times people will combine rest and splinting with heat or cold treatments. For some people, treatment with heat relieves the pain in the wrist . More frequently, there is greater relief of pain if cold treatments are used. These help to reduce inflammation.

Adjustments in the work area, work duties, or recreational activities may be necessary. This is frequently hard to do since many jobs, as well as recreational activities, revolve around the use of your hands. Some of the jobs that require a large amount of typing, use of tools that vibrate, or a lot of repetitive hand motions include receptionists, accountants, computer programmers, secretaries, construction workers, mine workers, and professional musicians.

Occupational counseling may be helpful.

Prognosis:
Symptoms often improve with treatment. More than 50% of cases eventually require surgery; the surgery usually cures the condition.

Complications:
If the condition is treated properly, there are usually no complications. If untreated, the nerve can be damaged, causing permanent weakness and muscle atrophy (loss of muscle tissue).

Call Your Healthcare Provider:
Call for an appointment with your health care provider if you have symptoms of carpal tunnel syndrome.

Call your health care provider if symptoms of carpal tunnel syndrome do not respond to treatment, or if there seems to be a loss of muscle mass in the fingers.


Carpal tunnel syndrome is becoming more frequently recognized and may be occurring more often. It may result from repetitive motion or the use of devices like computer keyboards. It affects the median nerve, the nerve that supplies feeling and movement to the thumb and "thumb-side" of the hand.