FAQs on Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a condition that causes numbness, pain, and weakness in the wrist and hands. CTS occurs due to increased pressure on the median nerve, which provides sensation to the index and middle fingers, as well as the thumb. The median nerve provides strength to the hand and wrist.

What is the carpal tunnel?

The carpal tunnel is a narrow canal of the wrist. The sides and bottom of the tunnel are composed of carpal bones (a small semi-circle of bones). A ligament forms the top of this tunnel, and the tendons and median nerve pass through the narrow space. CTS causes the tendons and nerve to swell.

What are the symptoms of carpal tunnel syndrome?

The symptoms of CTS begin slowly and gradually progress. Early symptoms include tingling, numbness, and pain of the fingers and thumb. Many people report nighttime symptoms that cause them to awaken during sleep. For some people with CTS, shaking the hands will relieve these symptoms. When carpal tunnel syndrome worsens, the symptoms become more constant. Late symptoms include weakness of the hand, inability to perform fine motor tasks, such as buttoning a shirt, and dropping objects.

Who gets carpal tunnel syndrome?

Certain persons are more at risk for carpal tunnel syndrome than others. Things that contribute to CTS include:

  • Pregnancy
  • Heredity
  • Hemodialysis
  • Diabetes
  • Thyroid gland hormone imbalance
  • Arthritis disease
  • Alcoholism
  • Older age
  • Mass or tumor of the wrist
  • Wrist or hand deformity
  • History of wrist dislocation or fracture

How is carpal tunnel syndrome diagnosed?

The doctor will first discuss your symptoms and take a medical history. The tests used to diagnose CTS include:

  • Phalen test – Also called the wrist flexion test, this involves having the wrist fall forward with the patient’s elbows on the table. A positive test is when the patient experiences tingling or numbness of the fingers within 60 seconds.
  • Tinel’s test – With this test, the doctor taps over the wrist on the median nerve. A positive test is when the patient reports tingling of the fingers.
  • X-rays – The doctor may order radiographs to assess for arthritis, injury, or fractures.
  • Electromyography (EMG) and nerve conduction studies (NCS) – These tests determine if the median nerve is working correctly, and how well the median nerve controls muscle movement.

How is carpal tunnel syndrome treated?

Treatment for carpal tunnel syndrome is different for every patient. Some patients respond to conservative measures whereas others require intensive therapies. Treatment options include:

  • Wrist splint – The wrist splint is worn to keep the wrist in a neutral position. Some patients wear the splint at night, whereas others also wear it during the day.
  • Cortisone injections – The doctor can inject the carpal tunnel with a long-acting corticosteroid to relieve inflammation. In a large systematic review regarding corticosteroid injections for CTS, the researchers found that injections offered significant clinical improvement in symptoms, with effects lasting for up to three months.
  • Physical therapy – The doctor may order a short course of physical therapy. The therapist uses heat, cold packs, electrical stimulation, and ultrasound for pain relief.
  • Surgery – When CTS does not respond to other treatments, or when the condition is debilitating, surgery is recommended. The aim of surgery is to increase the size of the carpal tunnel to decrease pressure on the tendons and nerves that must pass through it. This is done by releasing (cutting) the ligament over the tunnel and at the base of the palm.

What can I do for CTS?

Because carpal tunnel syndrome can be caused by repetitive use of the wrists, we recommend making certain work and home adjustments. These include:

  • Sleep with wrists straight.
  • Avoid flexing or extending the wrists repeatedly.
  • Keep the wrists straight when using tools.
  • Take frequent breaks from repetitive activities.
  • Decrease strong, repetitive grasping when the wrist is flexed.
  • Perform stretching and conditioning exercises before and after activities.

Resources

Marshall S, Tardif G, & Ashworth N (2007). Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Systematic Review, 18(2).