This information will help you understand what carpal tunnel syndrome is, some of its common causes, and how it can be treated.
Figure 1: Carpal tunnel
Your carpal tunnel is a narrow tunnel in your wrist that protects your median nerve and other tissues (see Figure 1). When the tissues in your carpal tunnel swell, they press on your median nerve. Your median nerve allows you to have feeling in your first 4 fingers, so when it's squeezed, it can make your hand hurt or feel numb. In some people, the carpal tunnel is small, which make them more likely to get carpal tunnel syndrome.
Some factors that can cause swelling are:
- Repeating the same wrist movements, or using your wrist too much
- Strenuous wrist movement
- Dislocations, sprains, or wrist injury
- Medical conditions, such as:
- Kidney failure
- Liver disease
- Amyloidosis (a disease in which proteins build up in your organs)
- Acromegaly (a disease that makes some bones get much larger than usual)
- Vitamin B6 deficiency
You may have just one, a few, or many symptoms of carpal tunnel syndrome, and your symptoms can change over time. Common symptoms include:
- Not being able to make a fist
Your doctor will diagnose carpal tunnel syndrome by:
- Reviewing your medical history
- Performing a physical exam
- Reviewing electromyography (EMG) results, which is a test that looks at muscles and nerves
- Reviewing the results of nerve conduction studies
Your doctor may also order blood work and x-rays. These tests are done to exclude other conditions that may be causing your problem.
The goal of treatment is to relieve the pressure on the median nerve, which will make your hand feel better. Treatment will also address any underlying cause. Some of the treatments that your doctor may suggest include:
- Resting your wrist to relieve the pressure on the nerve. Try to identify the activities that are making it worse so you can stop or change them.
- Splinting your wrist will keep your hand and wrist in a position that does not cause strain. This will help reduce the swelling that is pressing on your nerve, which will help decrease your symptoms. Wear your wrist splint as instructed by your doctor.
- Your doctor may suggest that you work with a physical or occupational therapist. The therapist will:
- Give you suggestions on how to change habits that may be causing the strain
- Adjust your wrist splint so that it fits correctly
- Show you how to move or hold your hand in a way that does not increase pressure on the median nerve
- Teach you exercises that will strengthen your hand and wrist
- Medication may be used to decrease the swelling. The most common types of medication used to help with carpal tunnel syndrome are nonsteroidal anti-inflammatory drugs (NSAIDs). These will help with the pain and reduce swelling. Examples of NSAIDs are ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g., Aleve®, Naprosyn®). NSAIDs should be taken with caution if you:
- Have a history of gastrointestinal, liver, or kidney disease
- Have a history of bleeding disorders
- Are taking aspirin or any medication that prevents your blood from clotting
- Are taking oral corticosteroids
Your doctor will tell you which medication is best for you. The doctor will base this on your symptoms and health history. You should take these medications according to your doctor's instructions.
- Steroid injections (shots) into the carpal tunnel area will reduce the swelling. A decrease in swelling may help to decrease pain. Steroid shots are used in patients that still have pain after trying other therapies. These injections may help with the pain and swelling for several weeks or months.
- Surgery may be an option if you have a lot of pain and severe limitations in your movement. It would be considered only after trying other treatments for at least 6 months. The surgery will release pressure on the nerve with the goal of reducing your pain.