Carpal Tunnel Syndrome

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a type of pinched nerve. You may have pain, numbness, tingling and weakness in the affected hand and fingers.

The cause of carpal tunnel syndrome is pressure on the median nerve, which runs through an opening in your wrist and hand called the carpal tunnel. It affects up to 10 million Americans. Certain conditions, as well as repetitive hand and wrist movements, cause carpal tunnel syndrome.

What does carpal tunnel syndrome feel like?

Carpal tunnel syndrome causes numbness or tingling in your thumb and fingers. You may also lose grip strength. 

These symptoms may come and go at first and then become chronic as the condition worsens. 

Most people develop carpal tunnel syndrome in their dominant hand, but it can affect both hands. 

Signs of carpal tunnel syndrome include:

• Clumsiness with your hands, such as dropping items
• Feeling like your fingers are swollen when they’re not
• Hand weakness that makes it hard to button clothes, hold items or do daily tasks 
• Numbness, tingling, burning or shock-like sensations in your fingers and thumb 
• Pain or tingling 
• Pins-and-needles sensation that wakes you from sleep or is worse in the morning

When should you see a medical professional?

You should see your primary care physician if symptoms affect your ability to complete daily tasks, work or sleep.

Your doctor may refer you to one of these specialists:

• Hand and wrist surgeon
• Neurosurgeon
• Orthopedic surgeon
• Physical therapist or occupational therapist

Why do you get carpal tunnel syndrome?

Different conditions and medications, as well as repetitive, forceful hand and wrist movements, can cause carpal tunnel syndrome.

The median nerve, which helps you move your lower arm (forearm), hand and fingers, runs through the carpal tunnel. Connective tissues called tendons are also in this tunnel. When something irritates a tendon, it can swell and put pressure on the median nerve. 

Are you at risk for carpal tunnel syndrome?

Anyone can get carpal tunnel syndrome. It’s more common in women between the ages of 40 and 60.

Carpal tunnel syndrome can affect members of the same family. Your family may naturally have a narrower carpal tunnel, which increases the risk of nerve compression. 

Conditions that increase your risk for carpal tunnel syndrome

Having one or more of these conditions can increase your risk for carpal tunnel syndrome:

• Broken, dislocated or sprained wrist
• Diabetes
• Inflammatory arthritis, including gout and rheumatoid arthritis
• Heart conditions, such as cardiac amyloidosis and heart failure
• Obesity
• Pituitary gland or thyroid gland conditions
• Pregnancy and menopause

Other carpal tunnel syndrome risk factors

Other risk factors for carpal tunnel syndrome include:

• Bending or extending your wrist for a prolonged time, such as while typing, texting, driving or holding a book or phone
• Hormonal birth control
• Repetitive hand and wrist motions in certain jobs or hobbies, such as hairstyling, carpentry and painting
• Using vibrating power tools, such as drills and jackhammers

How do doctors diagnose carpal tunnel syndrome?

In most cases, doctors diagnose carpal tunnel syndrome based on symptoms and a physical exam. 

During a physical exam, your doctor may perform these tests:

• Phalen’s test: Your doctor bends and moves your hand and wrists in different positions to check for numbness, weakness or tingling.
• Tinel’s test: Your doctor gently taps the skin above the median nerve in your wrist with their fingers or a reflex hammer. A tingling sensation, known as Tinel’s sign, may indicate a pinched nerve.

Additional tests for carpal tunnel syndrome 

Your doctor may order additional tests to check your nerve health and determine the severity of the condition. These tests may include:

• Electromyography and nerve conduction study to check for nerve and muscle damage.
• X-ray to show fractures. 
• Ultrasound to show signs of nerve compression or enlargement.
• MRI to help your doctor see conditions that cause nerve damage, such as tumors.

How do doctors treat carpal tunnel syndrome?

Early treatment of carpal tunnel syndrome can keep the condition from getting worse and may help you avoid surgery.

Our doctors always start with the least invasive methods. Treatments may include:

Nonsurgical treatments for carpal tunnel syndrome

Nonsurgical treatments include:

• Nonsteroidal anti-inflammatory drugs (NSAIDS) to reduce swelling and pain
• Occupational therapy to make changes to your work environment, including how you sit, stand, move or hold items
• Physical therapy to learn nerve gliding exercises that help the median nerve move better inside the carpal tunnel
• Platelet-rich plasma (PRP) therapy to boost your body’s natural healing process
• Steroid injections to ease swelling that causes pain
• Wrist brace (splint) to take pressure off the nerve while you sleep or do activities that cause symptoms

Carpal tunnel release surgery

If symptoms don’t improve after several months of nonsurgical treatments, your doctor may recommend carpal tunnel release surgery. During this procedure, your surgeon releases the transverse carpal ligament that runs along the top of the carpal tunnel. The most common surgery, open carpal tunnel release, takes place through a two-inch incision in your wrist.

Some surgeons perform minimally invasive endoscopic carpal tunnel release surgery for eligible patients. During this procedure, your surgeon: 

1. Makes half-inch cuts in your wrist and palm
2. Inserts an endoscope, a tiny scope device with a camera and light, into the wrist incision
3. Inserts a tiny surgical instrument into the hand incision
4. Cuts and releases the ligament, using the images from the camera as a guide

Cutting the ligament doesn’t affect your ability to use your wrist, hand and fingers. It creates more space inside the tunnel for tendons, reducing pressure on the median nerve. Endoscopic and open carpal tunnel release surgeries are outpatient procedures, so you go home the same day.

What’s the outlook when you have carpal tunnel syndrome?

Starting treatment early is key to keeping the condition from getting worse and reducing the need for surgery. 

If you don’t treat carpal tunnel syndrome, you may permanently lose feeling, strength and function in your fingers or thumb. These changes can make it difficult to do routine tasks, such as getting dressed, driving and using your phone. It can take up to a year for symptoms to improve. In some cases, muscle weakness may be permanent. Still, surgery can help preserve the remaining muscle strength. 

Can you prevent carpal tunnel syndrome?

Yes, certain actions can help lower your risk of developing carpal tunnel syndrome.

You can:

• Minimize repetitive hand and wrist motions when possible.
• Modify your workstation, or change your arm and hand positions, when working on a computer.
• Stretch your hands and wrists before activities.
• Take frequent breaks when working with your hands.
• Practice good wrist posture and use a wrist rest when using a keyboard or mouse.
• Wear a wrist splint at night or when doing activities that require a lot of hand movements.