Carpal tunnel syndrome

Carpal tunnel syndrome is numbness, tingling, weakness, pain, and other problems in your hand that are caused by pressure on the median nerve in your wrist.

The median nerve and several tendons run from your forearm to your hand. They pass through a small space in your wrist called the carpal tunnel. The median nerve controls movement and feeling in your thumb and first three fingers. It doesn't control movement of your little finger.

Carpal tunnel syndrome can cause tingling, numbness, weakness, or pain. Mild carpal tunnel symptoms most often affect the hand and sometimes the forearm. But they can spread up to the shoulder. You may first notice symptoms at night. Or you may notice stiffness in your fingers in the morning. You may be able to get relief by shaking your hand.

With moderate or severe symptoms, you may have numbness or reduced strength and grip in your fingers, thumb, or hand. For example, you may have a hard time holding a fork or opening a jar.

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. This is because the nerve involved in carpal tunnel syndrome doesn't affect the little finger.

To diagnose carpal tunnel syndrome, your doctor will ask if you have any health problems, such as arthritis, hypothyroidism, or diabetes. The doctor may ask if you are pregnant. The doctor 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. The doctor may suggest having tests, such as:

• Nerve testing to check the median nerve.
• An ultrasound to look at the size of the median nerve.
• An MRI to find out what is putting pressure on the median nerve.
• Blood tests to check for a thyroid problem, rheumatoid arthritis, or other conditions.

Treatment for carpal tunnel syndrome is based on how serious it is, if there is any nerve damage, and if other treatment has helped.

If your symptoms are mild, home treatment for 1 to 2 weeks is likely to relieve your symptoms. Try these tips.

• Wear a wrist splint.
• Stop or change activities that cause numbness and pain.
• Ice your wrist.
• Try nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.

Corticosteroids may treat the swelling of the nerve and your pain. They can be taken in pill form or injected into the wrist by a doctor. Physical therapy or occupational therapy is sometimes used.

Surgery is an option. But it's mostly 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.

The sooner you start treatment, the better your chances are to stop symptoms and prevent long-term damage to the nerve.

• If possible, stop or reduce the activity that causes your symptoms. If you cannot stop the activity, take frequent breaks to rest and stretch or change hand positions to do a task. Try switching hands, such as when using a computer mouse.
• Try to avoid bending or twisting your wrists.
• Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.
• If your doctor prescribes corticosteroid medicine to help reduce pain and swelling, take it exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Put ice or a cold pack on your wrist for 10 to 20 minutes at a time to ease pain. Put a thin cloth between the ice and your skin.
• If your doctor or your physical or occupational therapist tells you to wear a wrist splint, wear it as directed to keep your wrist in a neutral position. This also eases pressure on your median nerve.
• Ask your doctor whether you should have physical or occupational therapy to learn how to do tasks differently.
• Try a yoga class to stretch your muscles and build strength in your hands and wrists. Yoga has been shown to ease carpal tunnel symptoms.

To prevent carpal tunnel

• When working at a computer, keep your hands and wrists in line with your forearms. Hold your elbows close to your sides. Take a break every 10 to 15 minutes.
• Try these exercises:
  • Warm up: Rotate your wrist up, down, and from side to side. Repeat this 4 times. Stretch your fingers far apart, relax them, then stretch them again. Repeat 4 times. Stretch your thumb by pulling it back gently, holding it, and then releasing it. Repeat 4 times.
  • Prayer stretch: Start with your palms together in front of your chest just below your chin. Slowly lower your hands toward your waistline while keeping your hands close to your stomach and your palms together until you feel a mild to moderate stretch under your forearms. Hold for 10 to 20 seconds. Repeat 4 times.
  • Wrist flexor stretch: Hold your arm in front of you with your palm up. Bend your wrist, pointing your hand toward the floor. With your other hand, gently bend your wrist further until you feel a mild to moderate stretch in your forearm. Hold for 10 to 20 seconds. Repeat 4 times.
  • Wrist extensor stretch: Repeat the steps for the wrist flexor stretch, but begin with your extended hand palm down.
• Squeeze a rubber exercise ball several times a day to keep your hands and fingers strong.
• Avoid holding objects (such as a book) in one position for a long time. When possible, use your whole hand to grasp an object. Using just the thumb and index finger can put stress on the wrist.
• Do not smoke. It can make this condition worse by reducing blood flow to the median nerve. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.