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Carpal tunnel syndrome

Carpal tunnel syndrome is a condition in which a nerve in your wrist comes under pressure. This causes pain, tingling or weakness, mainly in your forearm and hand.

Carpal tunnel syndrome is more common in women than men. It affects about three in 100 men and four to five in 100 women at some point in their life. People aged between 45 and 65 are more commonly affected and it’s rare for it to affect children.

Your carpal tunnel is a channel in your wrist. The bones of your wrist are arranged in a semi-circle that forms the sides and base of this channel. A tough band of tissue, known as the transverse carpal ligament, forms the roof. The tendons that you use to flex your fingers and wrist pass through your carpal tunnel. Your carpal tunnel also surrounds your median nerve, which supplies feeling and controls many muscles in your hand and thumb. If this nerve comes under pressure, it can lead to carpal tunnel syndrome.

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Image showing the carpal tunnel and median nerve

Details

  • Symptoms Symptoms of carpal tunnel syndrome

    If you have carpal tunnel syndrome, you may have symptoms including:

    • pain
    • numbness
    • a tingling and/or burning sensation
    • weakness

    These symptoms mainly affect your wrist and hand. You're most likely to get these symptoms in your thumb, index and middle fingers, and the side of your ring finger nearest to your thumb. You may also get aching or pain in your forearm, upper arm and shoulder.

    It’s common for both hands to be affected. If so, you will probably notice symptoms in your dominant hand first.

    Any weakness usually occurs in movements involving your thumb. You may find it difficult to grip things, or have trouble carrying out actions such as fastening buttons. Over time, your hand muscles may continue to get weaker. 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.

    It’s possible that your hand will change colour and the skin on your hand may become dry. You may also feel as though your fingers or hands are swollen, even though they don’t look it. If you have numbness, you may not be able to tell the different between hot and cold when you touch objects.

    At first, your symptoms may be mild or last for only short periods of time. They can happen at any time but often carpal tunnel syndrome is worse at night and may cause you to wake up. Your symptoms may get better if you shake your wrist or change its position.

    If you have any of these or similar symptoms, see your GP for advice.

  • Diagnosis Diagnosis of carpal tunnel syndrome

    Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history and might be able to diagnose carpal tunnel syndrome just by examining you and talking to you. He or she may test the feeling on the skin of your hand to see if there is any numbness. He or she may also ask you to move your fingers and thumb to test for muscle weakness.

    There are some tests that can help diagnose carpal tunnel syndrome, for example, the Phalen test. Your GP will ask you to flex your wrists (or they may hold your wrist). If you get any pain or numbness within one minute, it's possible that you have carpal tunnel syndrome. Another test is the Tinel test. This is where your GP taps or presses on your median nerve in your wrist to see if you get any tingling in your fingers.

    Your GP may refer you for a nerve conduction test if they can’t be sure of the diagnosis or before you have surgery. This test can show if there is any damage to your median nerve. A trained technician attaches wires to your fingers and wrist, and applies small electric pulses to measure how quickly messages pass through your median nerve.

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  • Treatment Treatment of carpal tunnel syndrome

    Treatment for carpal tunnel syndrome helps to relieve your symptoms by reducing the pressure on your median nerve. It may also stop your condition from getting any worse.

    If you only have mild symptoms, they may improve without any treatment after about six months, especially if you're pregnant or under 30.

    Self-help

    Resting your hands and wrists regularly may relieve mild symptoms of carpal tunnel syndrome. When your symptoms flare up, try applying a cold compress, such as an ice pack or ice wrapped in a towel. Don’t apply ice directly to your skin as it can damage it.

    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 carry out these actions or reduce how often you do them. It may also help to increase the amount of rest you take between periods of activity. Some people find that changing their mouse or keyboard shape can help, but there is little evidence to suggest this is effective.

    Medicines

    You may be offered steroid injections directly into your carpal tunnel. Your pain may get a little worse for a couple of days after the injection, but your symptoms should improve after that. However, you may find that your symptoms return after a few months, especially if they were serious to begin with. There’s no evidence that another injection will relieve your symptoms any further.

    An injection is usually offered rather than steroid tablets. This is because it’s more effective and there are side-effect with the tablets if you take them for a long time. They aren’t usually recommended.

    Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help to relieve pain in the short term. However, they can cause side-effects and there is little evidence that they have much effect on carpal tunnel syndrome unless it's caused by underlying inflammation.

    Diuretic medicines (water tablets) don't appear to have any effect on the symptoms of carpal tunnel syndrome and aren’t recommended.

    Non-surgical treatments

    Wrist splints can help to keep your wrist straight and reduce pressure on the compressed nerve, and may relieve the symptoms of carpal tunnel syndrome. You’re likely to be advised to wear wrist splints at night for several weeks or months. Any improvement in your symptoms should happen within eight to 12 weeks. You can wear splints during the day as well, but you may find that they get in the way as you go about your daily routine.

    Research has looked into whether ultrasound treatment can help reduce symptoms of carpal tunnel syndrome. At the moment, there’s not very much good evidence that suggests it may be effective. Further research is needed to find out how effective and safe this treatment is.

    Surgery

    If your symptoms are severe or other treatments haven’t worked for you, your GP may suggest that you have carpal tunnel release surgery. This operation involves cutting your carpal ligament to make more space for the nerves and tendons in your carpal tunnel. Evidence suggests that the procedure is more effective for treating carpal tunnel syndrome than splinting. But more research is needed to see if it’s a better treatment than steroid injection.

    Exercise therapy

    There’s 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 and tendon gliding exercises - can help.

    Complementary therapies

    Some individual studies suggest that acupuncture helps to relieve symptoms of carpal tunnel syndrome but the evidence is limited. Furthermore, a recent review of studies on acupuncture for this condition didn’t show convincing benefits. More research is needed before we know if acupuncture is effective as a treatment for carpal tunnel syndrome.

    There’s no evidence to suggest that chiropractic, vitamin B6 (pyroxidine) tablets or magnets can help. There is a small amount of evidence that yoga may help to reduce pain in some people with carpal tunnel syndrome, but more research is needed.

    Always seek advice from your GP or pharmacist before trying any complementary therapies or medicines. If you choose to try a complementary therapy, check that your therapist is connected to a recognised organisation.

  • Carpal tunnel treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including carpal tunnel treatment.

  • Causes Causes of carpal tunnel syndrome

    There isn't much space in your carpal tunnel so any swelling there can press on your median nerve, causing the symptoms of carpal tunnel syndrome. There are many reasons why this may happen, but often it’s not possible to find a specific cause.

    Some people simply have smaller carpal tunnels, which makes them more at risk of developing carpal tunnel syndrome. It’s thought that this tendency may run in families. Therefore, you may have a smaller carpal tunnel because other members of your family do. This means you will be more likely to develop problems if there is increased pressure on the nerve.

    You're more likely to develop the condition if you're overweight. The condition is also more common as you get older. More women than men develop the condition, possibly because women naturally have smaller carpal tunnels.

    You may be more likely to develop carpal tunnel syndrome if you have had an injury to your wrist such as a break or sprain, or have certain diseases, including:

    • diabetes
    • osteoarthritis
    • rheumatoid arthritis
    • underactive thyroid

    It’s possible that hormones have something to do with carpal tunnel syndrome as some women develop the condition during pregnancy or the menopause. Hormones released during pregnancy can result in fluid retention in the tissues and increased pressure in your carpal tunnel. See our frequently asked questions for more information.

    Carrying out certain actions may lead to carpal tunnel syndrome. People whose work or hobbies include a lot of repetitive wrist actions may be more likely to get it, especially if they need to use a forceful grip. Working with vibrating tools can also make carpal tunnel syndrome more likely. At the moment, there’s no strong evidence that working with a computer mouse or keyboards causes this condition.

  • FAQs FAQs

    I have carpal tunnel syndrome and I'm pregnant. Are steroids safe to use during pregnancy?

    Answer

    Corticosteroid injections are often prescribed to treat carpal tunnel syndrome. There is limited evidence about whether or not taking these medicines during pregnancy will harm your baby.

    Explanation

    It's important to tell your GP if you think you might be pregnant as they will try to treat you without using steroid medicines. This is because there is some evidence that taking these during pregnancy may affect your baby’s growth and development.

    Some corticosteroids can cross the placenta and enter your baby's bloodstream. It’s not thought that taking a short course of these medicines during pregnancy will harm your baby, but the evidence is limited.

    If you're in great discomfort and other types of treatment haven't helped, your GP may suggest that you have a steroid injection. However, it’s important that you weigh up the risks and benefits of this treatment before going ahead. Your GP will discuss these with you.

    If you're pregnant and have carpal tunnel syndrome, your symptoms may get better once you have had your baby. This is because hormones that are released when you’re pregnant can lead to fluid retention, which may cause swelling in your carpal tunnel.

    I had a steroid injection for my carpal tunnel syndrome. How long will the effects of the injection last? Can I have another one if this wears off?

    Answer

    Some people find that their symptoms come back within a few months of having a corticosteroid injection for carpal tunnel syndrome. There’s little evidence to show that having a second injection will offer any further relief of your symptoms.

    Explanation

    Injections of corticosteroids have been found to be effective in improving the symptoms of carpal tunnel syndrome in the short term. They work by reducing inflammation in the carpal tunnel and so relieving pressure on the median nerve. However, many people find that their symptoms return after a few months.

    You may be able to have further injections if your symptoms return and the first injection worked for you for a while, but there is little evidence to show that this will give you any further relief.

    Some evidence suggests that having more steroid injections before having surgery for carpal tunnel syndrome is associated with more side-effects and complications afterwards.

    If your symptoms return after one injection, it’s likely that your GP will refer you to a doctor who specialises in conditions affecting the bones, joints and muscles for further treatment.

    Ask your GP for advice if you have had a steroid injection and your symptoms are getting worse again.

    What is the difference between carpal tunnel syndrome and repetitive strain injury?

    Answer

    Carpal tunnel syndrome is one of a number of disorders that can affect your arms and hands. One umbrella term for these disorders is repetitive strain injury (RSI).

    Explanation

    There are many disorders that can affect your neck, shoulder, arm and hand. RSI is often used as an umbrella term to describe these types of condition. Another term used to describe these is upper limb disorder (ULD), as it's not always repetitive actions that cause them. These conditions are often very painful and can stop you carrying out daily activities and interfere with your work.

    You may get carpal tunnel syndrome because of repetitive actions but there are many other causes too.

    If you think you have carpal tunnel syndrome or another condition that is causing RSI, see your GP for advice. Also, talk to your employer who may be able to advise you about workplace equipment and practices to help your symptoms.

  • Resources Resources

    Further information

    Sources

    • Kumar P, Clark M. Clinical medicine. 8th ed. Edinburgh: Saunders; 2012Atroshi I, Gummesson C, Johnsson R, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282(2):153–158. doi:10.1001/jama.282.2.153
    • Carpal tunnel syndrome. NICE Clinical Knowledge Summaries.cks.nice.org.uk, published September 2012
    • Bland J. Carpal tunnel syndrome. BMJ 2007; 335:343–6. doi:10.1136/bmj.39282.623553.AD
    • Bongers F, Schellevis F, van den Bosch W, et al. Carpal tunnel syndrome in general practice (1987 and 2001): incidence and the role of occupational and non-occupational factors. Br J Gen Pract 2007; 57(534):36–39
    • Van Meir N, De Smet L. Carpal tunnel syndrome in children. Acta Orthopaedica Belgica 2003. 69(5):387–94
    • Carpal tunnel syndrome. Medscape. www.emedicine.medscape.com, published 5 March 2013
    • Carpal tunnel syndrome fact sheet. National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov, published July 2012
    • Carpal tunnel syndrome fact sheet. Womenshealth.gov. www.womenshealth.gov , published 16 July 2012
    • Palmer K, Harris C, Coggon D. Carpal tunnel syndrome and its relation to occupation: a systematic literature review. Occup Med (Lond) 2007; 57(1):57–66. doi:10.1093/occmed/kql125
    • Barcenilla A, March L, Chen J, et al. Carpal tunnel syndrome and its relationship to occupation. Rheumatology 2012; 51(2):250–61. doi:10.1093/rheumatology/ker108
    • Musculoskeletal disorders and workplace factors. A critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. US Department of Health and Human services. Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health July 1997. www.cdc.gov
    • van Rijn R, Huisstede B, Koes B, et al. Associations between work-related factors and the carpal tunnel syndrome – a systematic review. Scand J Work Environ Health 2009; 35(1):19–36. doi:10.5271/sjweh.1306
    • Thomsen J, Gerr F, Atroshi I. Carpal tunnel syndrome and the use of computer mouse and keyboard: A systematic review. BMC Musculoskeletal Disorders 2008; 9:134. doi:10.1186/1471-2474-9-134
    • Carpal tunnel syndrome. Map of Medicine. www.mapofmedicine.com, published 23 November 2012
    • Commissioning guide: Treatment of painful tingling fingers. British Society for Surgery of the Hand (BSSH), British Orthopaedic Association (BOA), Royal College of Surgeons of England (RCSEng), 2013. www.rcseng.ac.uk
    • Marshall SC, Tardif G, Ashworth NL. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2007; Issue 2. doi:10.1002/14651858.CD001554.pub2
    • Carpal tunnel steroid injection. Medscape. www.emedicine.medscape.com, published 1 October 2012
    • O’Connor D, Marshall SC, Massy-Westropp N, et al. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2003, Issue 1. doi:10.1002/14651858.CD003219
    • Joint Formulary Committee. British National Formulary. 67th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2014. www.medicinescomplete.com
    • Page MJ, O’Connor D, Pitt V, et al. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2012, Issue 1. doi:10.1002/14651858.CD009601.pub2
    • Verdugo RJ, Salinas RA, Castillo JL, et al. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2008, Issue 4. doi:10.1002/14651858.CD001552.pub2
    • Page MJ, O’Connor D, Pitt V, et al. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2012, Issue 6. doi:10.1002/14651858.CD009899
    • Sim H, Shin B, Lee M, et al. Acupuncture for carpal tunnel syndrome: a systematic review of randomized controlled trials. J Pain 2011; 12(3):307–14. doi:10.1016/j.jpain.20. Reviewed by the University of York Centre for Reviews and Dissemination. www.crd.york.ac.uk
    • Upper limb disorders. Health and Safety Executive. www.hse.gov.uk, accessed 9 April 2014
    • Page MJ, Massy-Westropp, O’Connor D, et al. Splinting for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2012, Issue 7. doi:10.1002/14651858.CD010003
    • Tallia AF, Cardon DA. Diagnostic and therapeutic injection of the wrist and hand region. Am Fam Physician 2003; 67(4):745–50
    • Armstrong T, Devor W, Borschel L, et al. Intracarpal steroid injection is safe and effective for short-term management of carpal tunnel syndrome. Muscle Nerve 2004; 29(1):82–8. doi:10.1002/mus.10512
    • Vahi PS, Kals M, Koiv L, et al. Preoperative corticosteroid injections are associated with worse long-term outcome of surgical carpal tunnel release. Acta Orthop 2014; 85(1):102–6. doi:10.3109/17453674.2013.867781
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    Reviewed by Natalie Heaton, Bupa Health Information Team, June 2014.

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