Diagnostics: Carpal Tunnel Syndrome

Overview

Carpal tunnel syndrome, caused by compression and irritation of the median nerve in the wrist, is a progressive neurologic condition that causes pain and weakness in the wrist or hand. The median nerve is responsible for both sensation and movement in the hand, particularly the thumb, index finger, and two middle fingers. Carpal tunnel syndrome affects an estimated 4 to 10 million Americans, primarily middle-aged to older individuals, and occurs 3 times more frequently in women than in men. According to the American College of Rheumatology, carpal tunnel syndrome is possibly the most common nerve disorder experienced today.

Signs and Symptoms

While the signs and symptoms vary from person to person, the primary symptoms associated with carpal tunnel syndrome include tingling and/or numbness in the fingers and/or hand, especially the thumb, index finger, and middle fingers. Symptoms tend to develop and worsen over time. Other signs and symptoms include the following:

• Weakness or decreased grip strength
• “Pins and needles” sensation in the hand
• Stiffness in the fingers upon waking
• Difficulty feeling and handling small objects
• Occasional aching pain in the forearm between the elbow and wrist

Cause/Common Triggers

Carpal tunnel syndrome is often due to a number of factors that cause increased pressure on the median nerve and tendons in the carpal tunnel. Risk factors associated with the development of carpal tunnel syndrome may include the following:

• Fluid retention during pregnancy or menopause
• Being overweight
• Family history of carpal tunnel syndrome
• Various medical conditions, such as thyroid disease, diabetes, and arthritis
• Injuries such as wrist fractures
• Work that requires repetitive motion of the hands and wrists (eg, typing)

Debate continues about the causal relationship between carpal tunnel syndrome and repetitive motions of the hand and wrist during work or leisure activities.

Tests and Diagnosis

If you suspect that you have carpal tunnel syndrome or if your symptoms are persistent or worsening, your doctor will review your medical history and symptoms as well as conduct a physical and neurologic exam. Other medical tests such as an x-ray and/or an electromyogram or nerve conduction study may be ordered to rule out other medical conditions.

Prevention

Although no known methods exist to prevent carpal tunnel syndrome, you can reduce hand and wrist stress as well as carpal tunnel symptoms by taking the following the measures:

• Take frequent breaks, and rest your hands periodically.
• Perform stretching exercises.
• Relax your grip and reduce the force with which you use your hands.
• Improve your posture, especially when typing on a computer.
• Keep your hands warm and flexible.
• Alternate tasks to reduce the duration of repetitive motions.
• Modify your work space to reduce stress on your wrist and hands.

Management

A number of lifestyle changes can be incorporated to help individuals successfully manage the symptoms associated with carpal tunnel syndrome:

• Undergoing physical or occupational therapy
• Using splints, especially at night
• Avoiding activities that may cause stress in your hands and wrists
• Taking breaks when needed

Treatment and Care

Treatment for carpal tunnel syndrome should be initiated soon after diagnosis. Individuals with mild carpal tunnel syndrome can ease pain or discomfort by taking breaks from activities to rest their hands, applying cold or ice packs to ease any swelling, and avoiding activities that may worsen symptoms when possible. Your doctor may advise you to use wrist splint devices for support and/or mild pain relievers such as nonsteroidal anti-inflammatory drugs (NSAID). In some cases, corticosteroid injections or surgery may be recommended. Your doctor will determine the best treatment for you based on your symptoms, the severity of the condition, and your medical and medication history.

Homeopathic and Alternative Remedies

Many patients with carpal tunnel syndrome rely on alternative forms of treatment, including herbal remedies and homeopathic medicine. Alternative remedies may include the following:

• Yoga
• Hand therapy
• Ultrasound therapy
• Physical therapy
• Nutritional supplements

Patients should always check with a pharmacist or physician before taking any supplements, including herbal and homeopathic remedies, to prevent potentially harmful interactions and/or contraindications.

Self-Care

Most OTC products available for the treatment of carpal tunnel syndrome are aimed at providing pain relief and reducing inflammation. Patients may elect to use NSAID, acetaminophen, or herbal supplements to help manage the symptoms. To prevent drug interactions or adverse reactions, it is important to discuss these products with a physician or a pharmacist before using them.

Resources for Patients

• American Chronic Pain Association
• Medline Plus
• National Institutes of Health

Resources for Health Care Professionals

• American College of Rheumatology
• American Academy of Pain Management
• National Institutes of Health
• American Academy of Orthopedic Surgeons