Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

From: MedlinePlus, National Library of Medicine

Carpal tunnel syndrome is the name for a group of problems that includes numbness, tingling, weakness, or pain in your wrist or hand. It's a very common condition that happens when a nerve in your wrist becomes squeezed.

The carpal tunnel is a narrow opening between the bones in your wrist and the ligament that holds them together. A nerve, called the median nerve, runs from your lower arm through the carpal tunnel and into your hand. This nerve provides feeling to your thumb and first three fingers. It also helps you move your thumb.

Tendons also run from your lower arm, through the carpal tunnel, and into your hand. The tendons connect your finger bones to muscles in your arm, so you can bend your fingers.

If the tendons become swollen or irritated inside the carpal tunnel, they may press on the nerve. The squeezed nerve may not work well, which can lead to numbness, weakness, and other symptoms of carpal tunnel syndrome.

What causes carpal tunnel syndrome?

From: MedlinePlus, National Library of Medicine

In certain cases, the cause of carpal tunnel syndrome is unknown. But it usually happens from a combination of things that affect the structures in your wrist, such as:

• Injury to your wrist that causes swelling, such as a sprain or broken bone
• Health conditions that can affect your nerves, joints, or other parts of your wrist, for example: Diabetes. Rheumatoid arthritis. A cyst or tumor in your wrist. Changes in certain hormones, which may cause swelling from extra fluid in your body. Examples include an underactive thyroid gland (hypothyroidism), pregnancy and menopause. Problems with the way your wrist is formed.
• Doing the same wrist and hand movements over and over, such as: Assembly line work. Carpentry or using tools that vibrate. Knitting, gardening, or sports, such as golf.

Researchers aren't sure whether long-term typing or computer use leads to carpal tunnel syndrome.

Who is more likely to develop carpal tunnel syndrome?

From: MedlinePlus, National Library of Medicine

Carpal tunnel syndrome usually happens only in adults. You're more likely to develop it if you:

• Are a woman. Women are three times more likely to have carpal tunnel syndrome than men.
• Have a health condition that may affect structures in your wrist.
• Do activities with repeated hand motions.
• Have had a wrist injury.
• Have a close relative who has had carpal tunnel syndrome, such as a parent, brother or sister.

What are the symptoms of carpal tunnel syndrome?

From: MedlinePlus, National Library of Medicine

You may feel numbness, tingling or burning in your fingers, especially in your thumb, index, and middle fingers. Symptoms often affect both hands.

In the early stages, symptoms usually:

As symptoms get worse, you may notice:

Without treatment, you could lose feeling in some fingers and have permanent weakness in your thumb. But early diagnosis and treatment can help prevent lasting damage.

• Start slowly in your dominant hand (the one you write with)
• Happen at night if you sleep with your wrists bent
• Tingling, pain, or weakness with certain activities, such as driving or holding a phone
• Difficulty grasping or holding small things
• Feeling like your fingers are swollen when they're not

How is carpal tunnel syndrome diagnosed?

From: MedlinePlus, National Library of Medicine

To find out if you have carpal tunnel syndrome, your health care provider will:

• Ask about your medical history
• Ask about your family health history
• Do a physical exam
• Order tests if needed, such as: Lab tests to look for diseases that may damage nerves X-rays to look for broken bones or arthritis Tests to measure the electrical activity in your nerves and muscles Ultrasound to check the nerve in the carpal tunnel

What are the treatments for carpal tunnel syndrome?

From: MedlinePlus, National Library of Medicine

It's easier to treat carpal tunnel syndrome early on, so you should start treatment as soon as possible. Your provider will first treat any health conditions you have that may cause your symptoms. The next step would be treatments for carpal tunnel syndrome. They may include:

• Wrist splints (usually worn at night).
• Rest.
• Medicines to reduce swelling and pain:
• Over-the-counter pain relievers, such as aspirin, ibuprofen, and naproxen sodium. Prescription steroids, either pills or an injection (shot) into your wrist.
• Other therapies (complementary and integrative medicine). Research shows that yoga may help with pain and weakness. Some people may find acupuncture and chiropractic care helpful, but research hasn't shown that these therapies can improve carpal tunnel syndrome. If you want to try other therapies, talk with your provider first.
• Surgery to make more space in the carpal tunnel. Surgery may be an option if your symptoms are severe and other treatments don't work. It involves cutting the wrist ligament to take pressure off the nerve. Recovery may take months. Carpal tunnel syndrome rarely comes back after surgery, but mild symptoms may last.

Can carpal tunnel syndrome be prevented?

From: MedlinePlus, National Library of Medicine

You may help prevent carpal tunnel syndrome if you protect your wrists:

• Use good posture to keep your wrists in a natural position.
• Keep your hands warm to keep your muscles flexible. Fingerless gloves may help.
• Take work breaks and vary your tasks.
• Stretch and exercise your hands and wrists.
• Organize your workspace and tools to reduce strain on your hands and wrists.

Genetic causes described in the linked summary

From: MedlinePlus Genetics

Carpal tunnel syndrome occurs when a nerve in the hand and forearm, known as the median nerve, gets pinched (compressed) within a passage called the carpal tunnel. The carpal tunnel is a narrow canal at the wrist through which the median nerve extends from the forearm to the hand and the first four fingers. It is surrounded by the wrist bones and connective tissues, which are tissues that support the body's joints and organs.

Carpal tunnel syndrome is often described as idiopathic because its cause is frequently unknown but can be influenced by lifestyle factors. Little is known about the genetic contributions to this condition. Most of the genes that have been studied provide instructions for making proteins that are components of connective tissues. Other genes associated with the condition play roles in nerve cell function, the immune system, or metabolism. Additionally, the width of the carpal tunnel varies among individuals; people with narrower passages are more likely to have nerve compression than are people with wider passages.

In carpal tunnel syndrome, nerve compression can be caused by many factors including inflammation of connective tissues surrounding the carpal tunnel, accumulation of fluids (edema) in the lower arm, hormonal changes, stress and trauma to the wrist, or obstructions within the carpal tunnel, such as a cyst or tumor. Carpal tunnel syndrome occurs in 20 to 45 percent of pregnant women, likely due to edema or hormonal changes, and often goes away at the end of the pregnancy.

Particular activities, often related to certain occupations, may increase a person's risk of developing carpal tunnel syndrome. Repeated use of tools that vibrate or require forceful movements can put stress on the wrist, causing swelling or inflammation around the carpal tunnel. Whether repeated tensing of the hand and wrist, caused by frequent computer use, increases the risk of carpal tunnel syndrome is unclear; the evidence is conflicting. It is likely that the impact of computer use on the development of carpal tunnel syndrome is minor.

While carpal tunnel syndrome can be a feature of many disorders, including obesity, alcohol use disorder, rheumatoid arthritis, type 1 diabetes, type 2 diabetes, hypothyroidism, kidney (renal) failure, transthyretin amyloidosis, and hereditary neuropathy with liability to pressure palsies, it usually occurs in people with no related health conditions.

Inheritance described in the linked summary

From: MedlinePlus Genetics

Carpal tunnel syndrome is a complex condition and is usually not inherited. However, having a close relative with carpal tunnel syndrome likely increases a person's risk of developing the condition.

When carpal tunnel syndrome occurs as part of a genetic syndrome, this feature follows the inheritance pattern of the syndrome.

Which doctor should you see?

The suggested department for discussing Carpal Tunnel Syndrome is Orthopaedics, with a orthopaedic specialist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

Additional services that may be relevant, depending on the findings, include: Clinical Genetics.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• What explains the change in pain, movement or function?
• Which activities need adjustment while the diagnosis is being clarified?
• What are the roles of rehabilitation, observation and surgery in this situation?

Treatment discussions and follow-up

Where the source describes treatments, these are an overview of possible care, not a prescription for an individual. Ask which option applies to the confirmed diagnosis, what benefit is expected, what adverse effects to watch for and how progress will be assessed. Availability, approvals and local practice can differ from the country described in the source.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.