What is carpal tunnel syndrome?

Tingling, numbness, and pain in the hands are common during pregnancy, especially in the last trimester. These problems are usually caused by carpal tunnel syndrome. They usually go away after pregnancy.

Carpal tunnel syndrome is caused by pressure on the median nerve in your wrist. This nerve runs through a small space in your wrist called the carpal tunnel. This nerve controls feeling in your thumb and first three fingers. When there is pressure on this nerve, your grip can be weak and your hand can be clumsy. The nerve doesn't control feeling in your little finger.

Anything that reduces the amount of space in the carpal tunnel can lead to carpal tunnel syndrome. So can anything that makes the median nerve more sensitive.

The swelling that is common in pregnancy can lead to carpal tunnel syndrome. You may be more likely to get carpal tunnel syndrome during pregnancy if you:

• Use forceful or repetitive hand and finger movements.
• Use equipment that vibrates.

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.

Most mild 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 when:

• Fluid buildup decreases, such as after pregnancy.
• You change or stop the activity that has caused your carpal tunnel syndrome.
• Other health problems that cause or contribute to your carpal tunnel symptoms improve.

Long-term carpal tunnel syndrome can cause:

• A loss of feeling and coordination in the fingers and hand. The thumb muscles can become weak and get smaller (atrophy). This can make it hard to grip or hold objects.
• Permanent damage to the median nerve. You may have trouble using the hand.

Mild carpal tunnel symptoms most often affect the hand and sometimes the forearm, but they can spread up to the shoulder. Symptoms include:

• Numbness or pain in your hand, forearm, or wrist that wakes you up at night. (Shaking or moving your fingers may ease this numbness and pain.)
• Occasional tingling, numbness, "pins-and-needles" sensation, or pain. The feeling is similar to your hand "falling asleep."
• Numbness or pain that gets worse while you use your hand or wrist. You are most likely to feel it when you grip an object with your hand or bend (flex) your wrist.
• Occasional aching pain in your forearm between your elbow and wrist.
• Stiffness in your fingers when you get up in the morning.

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:

• Do simple hand movements, such as brushing your hair or holding a fork. You may accidentally drop objects.
• Pinch an object between your thumb and first finger. (This is called loss of pinch strength.)
• Use your thumb while doing simple tasks such as opening a jar or using a screwdriver. With long-term carpal tunnel syndrome, the thumb muscles can get smaller and weaker (atrophy).

Symptoms most often occur in parts of the hand supplied by the median nerve. These are 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:

• An injury to the muscles, ligaments, tendons, or bones.
• Nerve problems in the fingers, elbow, or neck.
• Arthritis in the thumb joint or wrist.

You can treat mild symptoms of carpal tunnel syndrome with home care. This includes wearing a wrist splint, icing your wrist, and avoiding activities that cause the problem. Corticosteroids taken by mouth or by injection are a treatment option. Surgery may be needed when you have severe symptoms and when other treatments haven't helped.

A wrist splint is a brace that looks like a fingerless glove. It stabilizes your wrist in a straight and sometimes slightly bent-back position. Wearing a wrist splint minimizes pressure on the median nerve and allows you a period of "relative rest" from movements that make carpal tunnel syndrome worse.

Think about these guidelines when you use a wrist splint:

• When worn to stabilize the wrist during sleep, a wrist splint can reduce pain and pressure on the median nerve.
• A wrist splint isn't a substitute for good workplace design and proper body mechanics. Some experts advise against wearing a wrist splint while working, because doing so can strain the hand's tendons.
• A wrist splint is a helpful short-term treatment for carpal tunnel syndrome. But long-term use can cause your muscles to weaken. During and after a period of splint use, exercise and slowly increase your hand and wrist movements. This will help prevent your wrist muscles from weakening.

Splints are available in drugstores without a prescription. They are also available by prescription from orthopedic and medical supply stores. Physical and occupational therapists can make custom-fit splints from lightweight materials that may be more comfortable to wear.

To help prevent carpal tunnel syndrome:

• Take good care of your general health. This includes staying at a weight that's healthy for you, not smoking, and getting regular exercise.
• Train yourself to use positions or techniques that won't stress your hand or wrist.
  • Keep your wrists straight, or only slightly bent, and in line with your arms. Avoid or change activities that bend or twist the wrists for long periods of time.
  • Take breaks often, and rest your hands.
  • Switch hands and change positions often when you are doing repeated motions.
  • Stop any activity that you think may be causing finger, hand, or wrist numbness or pain.
• Set up your work area to be ergonomic. This can include centering your work in front of you and keeping work at the proper height to avoid strain.

To diagnose this syndrome, your doctor will ask about health problems that could cause the condition. The doctor will ask about your routine and any recent activities that could have hurt your wrist, arm, or neck. You will get a physical exam, including comparing the strength of both hands. You may need nerve tests.

Medicine may relieve swelling, inflammation, and pain in the wrist or hand caused by carpal tunnel syndrome. Reducing swelling in the wrist will relieve pressure on the median nerve in the carpal tunnel. This helps relieve your symptoms.

Medicine choices include:

• Corticosteroids. These are powerful anti-inflammatory medicines. They can be used on their own or along with a wrist splint. Talk to your doctor about possible side effects. Corticosteroids can be taken in pill form or injected into the wrist by a doctor.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines can help relieve pain and reduce swelling. Studies haven't shown NSAIDs to be effective for carpal tunnel syndrome, but they may help relieve your symptoms. Be safe with medicines. Read and follow all instructions on the label. Do not take NSAIDs if you are taking corticosteroids.

Medicine should be used with other treatments (such as ice, rest, and splints) to reduce pain and inflammation.

Stop or reduce the activity causing your symptoms. Take breaks often. Try using a wrist splint at night to keep your wrist straight. Or put ice or a cold pack on your wrist for 10 to 20 minutes at a time. If your doctor prescribes medicine for pain and swelling, take it exactly as prescribed.

Surgery may be an option when other treatment hasn't helped, if you've had carpal tunnel syndrome for a long time, or if there's nerve damage or the risk of nerve damage.

The most common surgery for relieving carpal tunnel symptoms involves cutting the transverse carpal ligament. This helps relieve pressure on the median nerve in the wrist. Two approaches for this surgery may be used. They are:

• Open carpal tunnel release surgery. This requires a longer recovery time and leaves a larger scar than endoscopic surgery. But there may be less chance of other problems, like nerve damage or the need for a second surgery.
• Endoscopic carpal tunnel release surgery. Recovery is quicker than with open surgery. The scars heal sooner. They're smaller and tend to be less painful than they are in open release surgery. But there may be a slightly higher chance of needing another surgery later.

Some surgeons are now doing small- or mini-open release surgery. This requires a smaller incision than standard open release surgery. It may reduce healing time and scarring. It also allows the surgeon to view the ligament directly during the surgery. This helps to minimize danger to the nerve.

Your decision about whether to use open or endoscopic surgery may depend on your doctor's experience with the procedures. Endoscopic carpal tunnel surgery uses special equipment. It's most successful when the doctor has done the procedure many times.

Things that put you at risk for carpal tunnel syndrome include:

• Health problems that can cause arm pain, swelling in the joints and soft tissues in the arm, or reduce the blood flow to the hands. These include obesity, rheumatoid arthritis, pregnancy, diabetes, and hypothyroidism.
• Being female or pregnant. Those who are near the end of their pregnancies often have short-term symptoms.
• Hand and wrist activities that require repeated motions, especially in awkward positions.
• Smoking. It can affect blood flow to the median nerve in your wrist.
• Broken wrist bones, dislocated bones, new bone growth from healing bones, or bone spurs. These can take up space in the carpal tunnel and put more pressure on the median nerve.

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.