Overview
Carpal tunnel syndrome is a common condition caused by compression of the median nerve as it passes through the wrist, leading to numbness, tingling, and pain in the hand. It affects approximately 5% of adults and is 3 times more common in women than men.
The median nerve provides sensation to the thumb, index finger, middle finger, and half of the ring finger, and movement to some thumb muscles. The carpal tunnel is a narrow passage in the wrist formed by 8 small bones and the transverse carpal ligament.
Symptoms
Symptoms develop gradually:
- Numbness, tingling, burning sensation in the hand
- Especially in the thumb, index, and middle fingers
- Pain waking from sleep at night
- Wrist and palm pain
- Pain radiating to the arm, shoulder
- Dropping objects, decreased grip strength
- Wasting of thumb muscles (in advanced cases)
- Loss of fine motor skills (buttoning, holding a key)
- Difficulty making a fist
- Shaking hands upon waking ("flick sign")
Symptoms usually progress slowly and first appear in the dominant hand.
Causes
Compression of the median nerve within the carpal tunnel:
- Tendon inflammation
- Wrist position (constantly bent)
- Fluid retention
- Anatomical narrowing
Risk Factors
Anatomical:
- Congenitally narrow carpal tunnel
- Wrist fracture, dislocation
- Wrist arthrosis
Sex and hormones:
- Being female (3 times more common)
- Pregnancy (in 3rd trimester)
- Menopause
- Birth control pill use
Medical conditions:
- Diabetes
- Rheumatoid arthritis
- Hypothyroidism
- Acromegaly
- Amyloidosis
- Obesity
- Kidney failure, dialysis
Occupational and mechanical:
- Repetitive hand-wrist movements
- Working with vibrating tools
- Long-term keyboard-mouse use
- Cashier work
- Carpentry, assembly work
- Musicianship (piano, guitar)
- Sewing, knitting
Complications
- Permanent nerve damage
- Muscle atrophy (thumb)
- Permanent numbness
- Loss of dexterity
- Decreased quality of life
- Loss of work
When to See a Doctor
- When symptoms last more than 2 weeks
- If they disturb your sleep
- If they affect your daily activities
- Thumb muscle weakness
- Persistent numbness
- If you start dropping objects
Diagnosis and Treatment
Diagnosis:
- Clinical examination (Tinel and Phalen tests)
- EMG (electromyography) and nerve conduction study (definitive diagnosis and severity)
- Ultrasound
- MRI (in some cases)
- Investigation of underlying diseases (blood tests)
Treatment:
Conservative treatment is the first step in mild-moderate cases:
1. Conservative treatment:
- Wrist splint: Especially at night
- Activity modification: Avoiding repetitive movements
- Ice application
- NSAID pain relievers: Ibuprofen, naproxen
- Physical therapy: Nerve gliding exercises, ultrasound
- B6 vitamin, omega-3 (evidence limited)
- Yoga, stretching exercises
2. Cortisone injection:
- Into the carpal tunnel
- Temporary relief (weeks-months)
- Should not be done more than 2-3 times a year
3. Surgery (in resistant cases):
- Open carpal tunnel surgery: Cutting the transverse carpal ligament
- Endoscopic carpal tunnel surgery: Smaller incision, faster recovery
- With local anesthesia, outpatient
- Full recovery within 4-6 weeks
- High success rate (85-95%)
Prevention and Lifestyle
Workplace adjustments:
- Keep keyboard and mouse at the correct height
- Elbows at 90°, wrists neutral
- Use ergonomic keyboard, mouse
- Use armrests
- Take frequent breaks (5 minutes every hour)
- Keep your wrist relaxed
Exercises:
- Hand and wrist stretches
- Nerve gliding exercises
- Finger stretches
Lifestyle:
- Quit smoking
- Maintain a healthy weight
- Manage stress
- Do not sleep with fists clenched
- Wear wrist splint at night
Management of medical conditions:
- Monitor your diabetes
- Treat thyroid disease
- Keep rheumatologic diseases under control
- See your doctor for symptoms during pregnancy (usually resolves postpartum)