Carpal tunnel syndrome (patient information)

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Overview
Carpal tunnel syndrome is a painful progressive condition caused by compression of the median nerve in the wrist. It occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist.

What are the symptoms of Carpal tunnel syndrome?
Symptoms usually start gradually, with pain, weakness, or numbness in the hand and wrist, radiating up the arm. As symptoms worsen, people might feel tingling during the day, and decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. A sharp, piercing pain may shoot through the wrist and up your arm.

Patients often report:
 * Weak grip or difficulty carrying bags
 * Numbness or tingling in the thumb and next two or three fingers of one or both hands
 * Numbness or tingling of the palm of the hand
 * Pain extending to the elbow
 * Pain in the wrist or hand in one or both hands
 * Problems with fine finger movements (coordination) in one or both hands
 * Wasting away of the muscle under the thumb (in advanced or long-term cases)
 * Weakness in one or both hands

What causes Carpal tunnel syndrome?
The carpal tunnel is a narrow passageway of ligament and bones at the base of your hand that contains nerves and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the nerve to be compressed, putting pressure on the median nerve. The median nerve provides feeling and movement to the "thumb side" of the hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger).

In some cases no direct cause of the syndrome can be identified. Most likely the disorder is due to a congenital predisposition - some people have smaller carpal tunnels than other people do. Carpal tunnel syndrome is common in people who perform repetitive motions of the hand and wrist.

Typing on a computer keyboard is probably the most common cause of carpal tunnel. Other causes include:
 * performing assembly line work
 * Sewing
 * Driving
 * Assembly line work
 * Painting
 * Writing
 * Use of tools (especially hand tools or tools that vibrate)
 * Sports such as racquetball or handball
 * Playing some musical instruments

Other causes include wrist injury, or swelling due to certain diseases, such as rheumatoid arthritis. A number of medical problems are associated with carpal tunnel syndrome, including:
 * Bone fractures and arthritis of the wrist
 * Acromegaly
 * Diabetes
 * Alcoholism
 * Hypothyroidism
 * Kidney failure and dialysis
 * Menopause, premenstrual syndrome (PMS), and pregnancy
 * Infections
 * Obesity
 * Systemic lupus erythematosus (SLE)
 * Scleroderma

Who is at highest risk?
Women are three times more likely to have carpal tunnel syndrome than men. Additionally, those who perform assembly line work are especially at risk.

When to seek urgent medical care?
Call for an appointment with your health care provider if:
 * You have symptoms of carpal tunnel syndrome
 * Your symptoms do not respond to regular treatment, such as rest and anti-inflammatory medications, or if there seems to be a loss of muscle mass in your fingers

Diagnosis
During a physical examination, the doctor may find:
 * Numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger
 * Weak hand grip
 * Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand (this is called Tinel's sign)
 * Bending the wrist forward all the way for 60 seconds will usually result in numbness, tingling, or weakness (this is called Phalen's test)

Tests may include:
 * Electromyography
 * Nerve conduction velocity
 * Wrist x-rays, to rule out other problems (such as wrist arthritis)

Treatment options
Treatment includes resting your hand, splints, pain and anti-inflammatory medicines, and surgery.

Initial treatment generally involves:
 * resting the affected hand and wrist for at least 2 weeks
 * avoiding activities that may worsen symptoms
 * immobilizing the wrist in a splint to avoid further damage from twisting or bending.

For pain relief, the following may help patients:
 * Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and other nonprescription pain relievers
 * Cool (ice) packs
 * Prednisone (taken by mouth) or lidocaine (injected directly into the wrist) can relieve swelling and pressure on the median nerve and provide immediate, temporary relief.

Sometimes, your doctor may recommend 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 its severity.

Where to find medical care for Carpal tunnel syndrome?
Directions to Hospitals Treating Carpel tunnel syndrome

What to expect (Outlook/Prognosis)?
Symptoms often improve with treatment, but more than 50% of cases eventually require surgery. Surgery is often successful, but full healing can take months.

Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.

Possible complications
If the condition is treated properly, there are usually no complications. If untreated, the nerve can be damaged, causing permanent weakness, numbness, and tingling.

Prevention
To prevent workplace-related carpal tunnel syndrome, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Using special computer keyboards, different types of mouses, cushioned mouse pads, and keyboard drawers can also help.