Carpal Tunnel Syndrome

Carpal tunnel syndrome is a disorder of the nervous system in the wrist that causes pain, hand weakness, and/or loss of feeling. Carpal tunnel syndrome is caused by the compression, stretching, or irritation of the median nerve at the wrist joint. Athletes who experience carpal tunnel syndrome may notice a decrease in their performance to the condition, especially for sports that require strong hand or wrist action.

SYMPTOMS

  • Tingling, numbness, or burning pain in the hand or fingers.

  • Inability to sleep due to pain in the hand.

  • Sharp pains that shoot from the wrist up the arm or to the fingers, especially at night.

  • Morning stiffness or cramping of the hand.

  • Thumb weakness, resulting in difficulty holding objects or making a fist.

  • Shiny, dry skin on the hand.

  • Reduced performance in any sport requiring a strong grip.

CAUSES

  • Median nerve damage at the wrist is caused by pressure due to swelling, inflammation, or scarred tissue.

  • Sources of pressure include:

  • Repetitive gripping or squeezing that causes inflammation of the tendon sheaths.

  • Scarring or shortening of the ligament that covers the median nerve.

  • Traumatic injury to the wrist or forearm such as fracture, sprain, or dislocation.

  • Prolonged hyperextension (wrist bent backward) or hyperflexion (wrist bent downward) of the wrist.

RISK INCREASES WITH:

  • Diabetes mellitus.

  • Menopause or amenorrhea.

  • Rheumatoid arthritis.

  • Raynaud's disease.

  • Pregnancy.

  • Gout.

  • Kidney disease.

  • Ganglion cyst.

  • Repetitive hand or wrist action.

  • Hypothyroidism (underactive thyroid gland).

  • Repetitive jolting or shaking of the hands or wrist.

  • Prolonged forceful weight-bearing on the hands.

PREVENTION

  • Bracing the hand and wrist straight during activities that involve repetitive grasping.

  • For activities that require prolonged extension of the wrist (bending towards the top of the forearm) periodically change the position of your wrists.

  • Learn and use proper technique in activities that result in the wrist position in neutral to slight extension.

  • Avoid bending the wrist into full extension or flexion (up or down)

  • Keep the wrist in a straight (neutral) position. To keep the wrist in this position, wear a splint.

  • Avoid repetitive hand and wrist motions.

  • When possible avoid prolonged grasping of items (steering wheel of a car, a pen, a vacuum cleaner, or a rake).

  • Loosen your grip for activities that require prolonged grasping of items.

  • Place keyboards and writing surfaces at the correct height as to decrease strain on the wrist and hand.

  • Alternate work tasks to avoid prolonged wrist flexion.

  • Avoid pinching activities (needlework and writing) as they may irritate your carpal tunnel syndrome.

  • If these activities are necessary, complete them for shorter periods of time.

  • When writing, use a felt tip or roller ball pen and/or build up the grip on a pen to decrease the forces required for writing.

PROGNOSIS

Carpal tunnel syndrome is usually curable with appropriate conservative treatment and sometimes resolves spontaneously. For some cases, surgery is necessary, especially if muscle wasting or nerve changes have developed.

RELATED COMPLICATIONS

  • Permanent numbness and a weak thumb or fingers in the affected hand.

  • Permanent paralysis of a portion of the hand and fingers.

TREATMENT

Treatment initially consists of stopping activities that aggravate the symptoms as well as medication and ice to reduce inflammation. A wrist splint is often recommended for wear during activities of repetitive motion as well as at night. It is also important to learn and use proper technique when performing activities that typically cause pain. On occasion, a corticosteroid injection may be given.

If symptoms persist despite conservative treatment, surgery may be an option. Surgical techniques free the pinched or compressed nerve. Carpal tunnel surgery is usually performed on an outpatient basis, meaning you go home the same day as surgery. These procedures provide almost complete relief of all symptoms in 95% of patients. Expect at least 2 weeks for healing after surgery. For cases that are the result of repeated jolting or shaking of the hand or wrist or prolonged hyperextension, surgery is not usually recommended, because stretching of the median nerve and not compression are usually the cause of carpal tunnel syndrome in these cases.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers are usually only prescribed after surgery. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given to reduce inflammation. However, they are not always recommended.

  • Vitamin B6 (pyridoxine) may reduce symptoms; use only if prescribed for your disorder.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks despite treatment.

  • You also have a current or recent history of neck or shoulder injury that has resulted in pain or tingling elsewhere in your arm.