What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a condition that develops when the median nerve in the wrist and hand is compressed. This condition causes pain, tingling, numbness, and eventually weakness in the hand and fingers. You can manage, or even reverse, carpal tunnel syndrome with lifestyle changes, medication, and in severe cases, surgery.

This article discusses carpal tunnel syndrome—what it is, symptoms of the condition, how it is diagnosed, and treatment options.

Carpal Tunnel Syndrome Symptoms

Carpal tunnel syndrome causes pain in the part of the hand and fingers supplied by the median nerve (median nerve sensory distribution). This includes the palm side of the hand, including the thumb, index finger, middle finger, and half of the ring finger.

Other symptoms of carpal tunnel syndrome can include the following:

• Tingling in the median nerve distribution
• Numbness
• Increased pain at night
• Loss of sensation in the affected fingers
• Decreased grip and pinch strength
• Shrinkage (atrophy) of the muscles at the base of the thumb (thenar eminence)
• Feeling like the fingers are swollen or puffy
• Decreased range of motion in the fingers
• Difficulty determining temperatures by touch (such as hot vs. cold)
• Dropping objects

Causes of Carpal Tunnel Syndrome

The carpal tunnel contains eight tendons and the median nerve. Swelling or thickening of the tendons in the carpal tunnel can compress the median nerve, leading to carpal tunnel syndrome. The exact cause of this condition is not always known, but many factors can increase the risk of developing CTS.

These include:

• Female sex
• Experiencing obesity
• Pregnancy or menopause (due to fluid retention)
• A wrist fracture or other trauma
• Arthritis
• Diabetes
• Other metabolic disorders
• Increased age
• Sleeping on a bent wrist
• Thyroid or pituitary disorders
• Gout
• Ganglion cyst or tumor
• Bone spurs
• Infection
• Family history of carpal tunnel syndrome

Which Jobs Make Carpal Tunnel Syndrome Worse?

Some jobs and hobbies can increase your development of carpal tunnel syndrome—mainly if the job requires repetitive, forceful gripping, wrist bending, and vibrating tools. Examples include:

• Assembly line work
• Painting
• Playing the piano
• Construction

Carpal tunnel syndrome can also develop from sedentary desk jobs that require a lot of typing or writing—especially if the workstation is not set up correctly.

How Is Carpal Tunnel Syndrome Diagnosed?

Carpal tunnel syndrome is diagnosed through physical exams and tests to assess nerve function. During a physical exam, a healthcare provider may perform tests, such as Tinel's sign or Phalen's test, to reproduce your symptoms if you have carpal tunnel syndrome.

A provider might also perform a nerve function test to assess the extent of damage caused to the median nerve with CTS. These include:

• Nerve conduction study: This test measures the intensity and speed of electrical impulses as they travel along the median nerve. With CTS, this intensity and speed can decrease.
• Electromyography (EMG): This test involves placing tiny needles into various muscles supplied by the median nerve to measure the amount of electrical activity in these muscles. Abnormal electrical activity detected by EMG can be a sign of CTS.
  

How Is Carpal Tunnel Syndrome Treated?

Treatment for carpal tunnel syndrome can range from lifestyle changes to surgery, depending on the severity of nerve damage at diagnosis.

Lifestyle Changes

Minor changes to your daily activities can help decrease symptoms of carpal tunnel syndrome and possibly reverse the condition. These can include:

• Avoiding aggravating activities: Whenever possible, avoid activities that increase your symptoms. If you can't avoid them, take frequent daily breaks to rest your hand.
• Use ergonomic tools: Use ergonomic writing utensils and other devices with thicker handles to reduce stress on your hand muscles during daily tasks.
• Wear a splint: Keeping the wrist in a neutral (straight) position reduces tension on the median nerve. Wear a splint while sleeping and during daily activities that cause your symptoms until your condition resolves.
• Sit with proper posture: Set up your workstation to reduce pressure on your median nerve and improve your posture.

Carpal Tunnel Exercises

Specific exercises can help reduce stiffness and improve a movement called nerve gliding with carpal tunnel syndrome. Tendons in the carpal tunnel are attached to muscles that move your wrist and fingers. Stretching these muscles can reduce tension and pain. Perform stretches several times throughout your day by doing the following:

• Spread your fingers apart, and bring them back together 10 times.
• Touch the tip of your thumb to the tip of each finger 10 times.
• Hold your arm straight out in front of you. Bend your wrist down. Gently apply pressure to the back of your hand with the opposite hand until you feel a stretch in your forearm. Hold for 30 seconds. Turn your forearm over and repeat in the opposite direction.
• Begin with your fingers straight. Bend the knuckles of your fingers, then bend them into a fist. Straighten the fingers back out. Repeat 10 times.
• Begin with your fingers straight. Bend only the large knuckles, making a tabletop with your fingers. Then bring the tips of your fingers to your palm. Straighten your fingers back out.

Nerve gliding exercises can help the median nerve move smoothly in the carpal tunnel. Move through this sequence slowly, several times per day:

• Make a fist.
• Keeping your thumb next to your hand, straighten your fingers.
• Bend your wrist backward.
• Move your thumb out to the side.
• Turn your forearm into a palm-up position.
• Use your other hand to apply gentle pressure to increase the stretch of your thumb.

More severe cases of carpal tunnel syndrome can cause weakness and decreased fine motor skills. A certified hand therapist (occupational or physical therapist) can provide you with an individualized exercise plan to address your specific limitations.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce symptoms of carpal tunnel syndrome. Examples include Advil or Motrin (ibuprofen), Aleve (naproxen), and Bayer (aspirin). Oral steroid medications or a cortisone injection might be required for more severe cases.

Surgery

In some cases, surgery—called carpal tunnel release—might be required to relieve pressure on the median nerve. This is one of the most common surgeries in the United States.

Carpal tunnel release involves cutting the ligament that forms the roof of the carpal tunnel. This can be done endoscopically by inserting tools into tiny incisions in the wrist or as an open procedure with a longer incision.

Symptoms of carpal tunnel syndrome can be reversed with surgery, but for some people, full recovery can take up to a year.

Preventing Carpal Tunnel Flares

Carpal tunnel syndrome symptoms can come and go. To help reduce the risk of flare-ups, continue to perform CTS exercises several times per week and use good ergonomics.

If your symptoms reoccur, address them early. Wear your splint, mainly while sleeping, to reduce pressure on your median nerve. See your healthcare provider if conservative treatment is not relieving your symptoms.