Carpal tunnel syndrome is a condition that causes pain or weakness in the forearm and hand. It's caused by pressure on a nerve in the wrist.
Your carpal tunnel is a channel in the palm side of your wrist. It’s formed by the semi-circle of wrist bones with a tough ligament known as the transverse carpal ligament forming a roof over these bones. The carpal tunnel surrounds the tendons you use to bend your fingers and wrist. It also surrounds your median nerve, which is one of three nerves that connect your wrist to your hand and controls some of the muscles that move your thumb.
You can get carpal tunnel syndrome if there’s too much pressure on your median nerve.
About three in 100 men and five in 100 women develop carpal tunnel syndrome at some point in their life.
If you have carpal tunnel syndrome, your hand and fingers may:
You're most likely to get these symptoms in your thumb, index and middle fingers and the side of your ring finger nearest your thumb. You may also get aching or pain in your forearm, shoulder and neck. Your symptoms may be mild or may last for only short periods of time.
Carpal tunnel syndrome tends to be worse at night or first thing in the morning. Your symptoms may get better after you’ve used your hand for a while, but may then come back later in the day.
If you have these symptoms, contact your GP for advice.
If your symptoms occur constantly, your hand muscles can become weak. This may make it more difficult for you to grip objects or perform other manual tasks. If you have severe, long-lasting carpal tunnel syndrome, your thumb muscles may start to waste away or your median nerve may become permanently damaged. Occasionally, you may experience changes to the colour and feel of the skin of your hand.
Because there isn't much room in your carpal tunnel, any swelling around it can press on your median nerve, causing the symptoms of carpal tunnel syndrome.
You're more likely to develop the condition if you're overweight or have a job where you use your hands a lot. You may also get carpal tunnel syndrome if you:
Carpal tunnel syndrome is more likely to affect women than men, and it tends to develop in people over 45.
One in four people who have carpal tunnel syndrome has a relative who also has the condition.
Your GP will ask you about your symptoms and examine you. They may also ask you about your medical history.
They may tap on your wrist and ask you to bend the palm of your hand to see if they can reproduce the symptoms of carpal tunnel syndrome. If this happens, it's likely that you have the condition.
If your GP isn't sure whether you have carpal tunnel syndrome, they may refer you to a neurologist (a doctor who specialises in conditions that affect the nervous system) for a nerve conduction test. This test can show if there’s any damage to your median nerve.
During the test, the neurologist will attach wires to your fingers and wrist and apply small electric shocks to measure how quickly messages pass through your median nerve.
Treatment helps to relieve your symptoms by reducing the pressure on your median nerve and may stop your condition getting any worse.
Sometimes carpal tunnel syndrome improves after six months without any treatment, especially if you're pregnant or under 30.
If repetitive hand movements are causing your condition, it's important to try to limit any activities that make your symptoms worse. It may help if you change the way you make repetitive movements, reduce how often you do them and increase the amount of rest you take between periods of activity.
Resting your hands and wrists regularly may relieve mild symptoms of carpal tunnel syndrome. Shaking your hands when they’re numb or tingling may also help.
When your symptoms flare up, try applying a cold compress, such as an ice pack or ice wrapped in a towel. You shouldn't apply ice directly to your skin as this can damage your skin.
Your GP may prescribe corticosteroid tablets in the short term to treat carpal tunnel syndrome. However, these medicines can cause side effects if you take them for a long time. Always read the accompanying consumer medicines information leaflet and if you have any questions or concerns ask your pharmacist or GP for advice.
Your GP may give you steroid injections into your carpal tunnel. Your pain may get a little worse for a couple of days after the injection, but after that your symptoms should improve.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, don't have much effect on carpal tunnel syndrome unless it's caused by an underlying inflammatory condition.
If you also have fluid retention in your wrist then your doctor may recommend diuretic medicines (fluid tablets) to help, but they won't improve your carpal tunnel symptoms alone.
Wrist splints help to keep your wrist straight and reduce pressure on the compressed nerve. Your doctor may recommend that you wear wrist splints either at night, or both day and night, although you may find they get in the way of daily activities.
Some research indicates that ultrasound treatment (treatment with sound waves) may help reduce the symptoms of carpal tunnel syndrome.
If your symptoms are severe, your GP may suggest that you have carpal tunnel release surgery. This operation involves a surgeon cutting your carpal ligament to make more space for the nerves and tendons in your carpal tunnel. It's usually done as day-case surgery under a local anaesthetic.
There is no scientific evidence that any general hand or wrist exercises can relieve the symptoms of carpal tunnel syndrome. More research is needed to see whether special hand exercises – called nerve tendon and gliding exercises – can help.
There is no scientific evidence to suggest that acupuncture helps to relieve symptoms of carpal tunnel syndrome. There is also no evidence to suggest that vitamin B6 (pyroxidine) tablets help. However, there is some evidence that performing yoga may help to reduce pain in people with carpal tunnel syndrome.
Always seek advice from your doctor or pharmacist before trying any complementary therapies. If you choose to try a complementary therapy, check that your therapist is affiliated to a recognised organisation.
Workers Health Centre
RSI and Overuse Injury Association of ACT
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Last published: 30 July 2011
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