syndrome is numbness, tingling, weakness, and other problems in your hand because of pressure
median nerve in your wrist.
nerve and several
tendons run from your forearm to your hand through a
small space in your wrist called the carpal tunnel. The median nerve controls
feeling in your thumb and first three fingers (not
your little finger).
the median nerve causes carpal tunnel syndrome. This pressure can come from
swelling or anything that makes the carpal tunnel smaller. Many things can cause this swelling, including:
Carpal tunnel syndrome can
cause tingling, numbness, weakness, or pain in the fingers or hand. Some people
may have pain in their arm between their hand and their elbow.
Symptoms most often occur in the thumb, index finger, middle finger, and
half of the ring finger. If you have problems with your other fingers but your
little finger is fine, this may be a sign that you have carpal tunnel syndrome.
A different nerve gives feeling to the little finger.
first notice symptoms at night. You may be able to get relief by shaking your
Your doctor will ask if you have any
health problems—such as arthritis, hypothyroidism, or diabetes—or if you are
pregnant. He or she will ask if you recently hurt your wrist, arm, or neck.
Your doctor will want to know about your daily routine and any recent
activities that could have hurt your wrist.
During the exam, your
doctor will check the feeling, strength, and appearance of your neck,
shoulders, arms, wrists, and hands. Your doctor may suggest
tests, such as blood tests or nerve tests.
Mild symptoms usually can be
treated with home care. You can:
The sooner you start treatment, the better your chances
of stopping symptoms and preventing long-term damage to the nerve.
may need medicine for carpal tunnel syndrome or for a health problem that made
you likely to get carpal tunnel syndrome.
Surgery is an option.
But it's usually used only when symptoms are so bad that you can't work or do
other things even after several weeks to months of other treatment.
To keep carpal tunnel syndrome from coming back, take care of
your basic health. Stay at a healthy weight. Don't smoke. Exercise to stay
strong and flexible. If you have a long-term health problem, such as arthritis
or diabetes, follow your doctor's advice for keeping your condition under
You can also try to take good care of your wrists and
Learning about carpal tunnel syndrome:
Health Tools help you make wise health decisions or take action to improve your health.
Carpal tunnel syndrome occurs when a combination of health conditions and activities
puts pressure on the
median nerve as it passes through the
carpal tunnel in your wrist. This pressure leads to
symptoms. Anything that decreases the amount of space in the carpal
tunnel, increases the amount of tissue in the tunnel, or increases the
sensitivity of the median nerve can lead to carpal tunnel syndrome.
Things that help cause carpal tunnel syndrome include:
Carpal tunnel syndrome is a common work-related condition.
It can be caused by work that requires:
Carpal tunnel syndrome is even more likely if you have these work-related issues along with other health conditions.
In some cases the cause of carpal tunnel
syndrome cannot be found.
Mild carpal tunnel symptoms most often affect the hand and
sometimes the forearm, but they can spread up to the shoulder. Symptoms
With moderate or severe carpal tunnel symptoms, you may
have numbness or reduced strength and grip in your fingers, thumb, or hand. It
may be hard to:
most often occur in parts of the hand supplied by the
median nerve: the thumb, the index finger, the middle finger,
and half of the ring finger. The median nerve doesn't affect your little finger. So if your little finger is affected, you may not have carpal tunnel syndrome.
Symptoms often occur in both hands, but they are usually worse in one hand
than the other. You may first notice symptoms at night. People with carpal
tunnel syndrome can usually fall asleep, but pain or numbness may wake them up.
Not all pain in the wrist or hand is caused by carpal
tunnel syndrome. There are many
other conditions with similar symptoms, such as:
The symptoms of
carpal tunnel syndrome usually develop gradually.
Symptoms often improve if you stop or change an activity that is
helping to cause the condition.
cases of carpal tunnel syndrome get better with treatment. Usually there is no
permanent damage to the
median nerve. Your symptoms may improve by themselves
Long-term carpal tunnel syndrome can cause:
tunnel syndrome is one of the most common causes of absence from
Things that put you at risk for
carpal tunnel syndrome include:
Call 911 or go to an emergency room immediately if you notice sudden loss of feeling in your
Call your doctor if you:
You can treat mild symptoms of wrist and hand
pain or numbness at home. You may try home treatment for 1 to 2 weeks before
calling your doctor.
To check your symptoms, you may first want to
consult the doctor who provides care for your other health conditions,
especially conditions that may be contributing to
carpal tunnel syndrome. (Health conditions such as
rheumatoid arthritis, hypothyroidism, or diabetes can all lead to carpal tunnel
syndrome.) Or, you may choose to see:
For more testing, see:
For treatment, see:
For surgery, see:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Carpal tunnel syndrome is usually diagnosed using:
If your symptoms are severe,
if nonsurgical treatment has not improved symptoms, or if your symptoms aren't
clearly caused by carpal tunnel syndrome, your doctor may recommend:
The goal of treatment for
carpal tunnel syndrome is to allow you to return to
your normal function and activities and to prevent nerve damage and loss of muscle strength in your fingers and hand.
Treatment options include:
Treatment for carpal tunnel syndrome is based on the
seriousness of the condition, whether there is any nerve damage, and whether
other treatment has helped. If your symptoms are
mild, 1 to 2 weeks of
home treatment are likely to relieve your symptoms.
To help prevent carpal tunnel syndrome:
If you feel that certain work activities are causing
finger, hand, or wrist numbness or pain, talk to your human resources
department. Ask about different ways of doing your job, changes in
your equipment, other job assignments, or the possibility of an ergonomics
evaluation of your work space and procedures. For more
information, see the topic
In daily routines at
home or while doing hobbies, think about changing activities in which you make
repeated finger, hand, or wrist movements. Train yourself to use other
positions or techniques that won't stress your hand or wrist.
Home treatment for
carpal tunnel syndrome:
If you have mild symptoms, such as occasional tingling,
numbness, weakness, or pain in your fingers or hand, follow these steps to
When your pain is gone, begin
exercises for flexibility and strength for your arm
and wrist. Learn the best positions and posture for hand and wrist
Medicine may relieve swelling,
inflammation, and pain in the wrist or hand related to carpal tunnel syndrome. Reducing
swelling in the wrist will relieve pressure on the
median nerve in the carpal tunnel and relieve your symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain
and inflammation and are available with or without a prescription. They work best if your tendon is inflamed. NSAIDS don't relieve pressure on the medium nerve, but they may make you feel better.
Corticosteroids may be a
treatment option when NSAIDs don't effectively relieve pain and
inflammation. But these are powerful
anti-inflammatory medicines. They have side effects that should be considered.
Corticosteroids can be taken in pill form or injected into the wrist by a
Medicine should be used with
other measures (such as ice, rest, and splints) to reduce pain and
Most people with
carpal tunnel syndrome are treated without surgery.
Surgery is considered only when:
The most common surgery for relieving carpal tunnel
symptoms involves cutting the transverse carpal ligament to relieve pressure on
the median nerve in the wrist. Two approaches for this surgery are:
Some surgeons are now doing small- or mini-open
release surgery. This requires a smaller incision than standard open carpal
tunnel release surgery. It may reduce healing time and scarring. But it also
allows the surgeon to view the ligament directly during the surgery to minimize
danger to the nerve itself. This procedure may be promising. But there are few
studies comparing it to the open carpal tunnel or endoscopic procedures at this
Nerve tests (nerve conduction velocity
test and electromyogram) are often completed before surgery is done. Surgery
is more likely to be successful if the results from nerve testing point to
carpal tunnel syndrome.
Your decision about whether to use open or endoscopic
surgery depends on your doctor's experience with the procedures. Endoscopic
carpal tunnel surgery uses very technical equipment and is most successful when
the doctor has done the procedure many times.
After surgery, it is important to avoid any activities that
may have caused carpal tunnel syndrome. Or you can change the way you do them.
Other treatments for
carpal tunnel syndrome include:
Some people try complementary and alternative treatments to help with the symptoms of tingling, numbness, weakness, or pain felt in
the fingers or hand. There is not strong evidence that they help.1 Some of these treatments include
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
The American College of Rheumatology (ACR) and the
Association of Rheumatology Health Professionals (ARHP, a division of ACR) are
professional organizations of rheumatologists and associated health
professionals who are dedicated to healing, preventing disability from, and
curing the many types of arthritis and related disabling and sometimes fatal
disorders of the joints, muscles, and bones. Members of the ACR are physicians;
members of the ARHP include research scientists, nurses, physical and
occupational therapists, psychologists, and social workers. Both the ACR and
the ARHP provide professional education for their members.
website offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
The American Occupational Therapy Association (AOTA) is the
nationally recognized professional association of approximately 35,000
occupational therapists, occupational therapy assistants, and students of
occupational therapy. AOTA's mission is to advance the quality, availability, use,
and support of occupational therapy through standard-setting, advocacy,
education, and research on behalf of its members and the public.
ASSH is a professional organization of hand surgeons
that provides education to the public about hand problems, such as Dupuytren's
disease, carpal tunnel syndrome, and tennis elbow. ASSH also provides education
about surgery, preventive tips to keep your hands safe, and an online tool to
find a hand surgeon.
CitationsAmerican Academy of Orthopaedic Surgeons (2008, reaffirmed 2011). Clinical Practice Guideline on the Treatment of Carpal Tunnel Syndrome. Available online: http://www.aaos.org/Research/guidelines/CTStreatmentguide.asp.Other Works ConsultedAmerican Academy of Orthopaedic Surgeons (2007). Clinical guideline on diagnosis of carpal tunnel syndrome. Available online: www.aaos.org/Research/guidelines/CTSdiagnosisguide.asp.American Academy of Orthopaedic Surgeons (2008, reaffirmed 2011). Clinical Practice Guideline on the Treatment of Carpal Tunnel Syndrome. Available online: http://www.aaos.org/Research/guidelines/CTStreatmentguide.asp.American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Carpal tunnel syndrome. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 436–440. Rosemont, IL: American Academy of Orthopaedic Surgeons.Bednar MS, Light TR (2006). Hand surgery. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 535–596. New York: McGraw-Hill.Mercier LR (2008). The forearm, wrist, and hand. In Practical Orthopedics, 6th ed, pp. 105–141. Philadelphia: Mosby Elsevier.National Institute of Neurological Disorders and Stroke (2009). Carpal tunnel syndrome fact sheet. Bethesda, MD: National Institutes of Health. Available online: http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm.Palmer KT, et al. (2007). Carpal tunnel syndrome and its relation to occupation: A systematic literature review. Occupational Medicine, 57(1): 57–66.Piazzini DB, et al. (2007). A systematic review of the conservative treatment of carpal tunnel syndrome. Clinical Rehabilitation, 21(4): 299–213.Thomsen JF, et al. (2008). Carpal tunnel syndrome and the use of computer mouse and keyboard. A systematic review. BMC Musculoskeletal Disorders, 9: 134. Available online: http://www.biomedcentral.com/1471-2474/9/134.Zhao M, Burke D (2008). Median neuropathy (carpal tunnel syndrome). In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation, 2nd ed., pp. 173–177. Philadelphia: Saunders Elsevier.
October 2, 2012
Kathleen Romito, MD - Family Medicine & Herbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery
To learn more visit Healthwise.org
© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.