Carpal tunnel syndrome
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Carpal tunnel syndrome
Classification and external resources

Transverse section at the wrist. The median nerve is colored yellow. The carpal tunnel consists of the bones and flexor retinaculum. ICD-10 ICD-9 OMIM G56.0 354.0 115430

DiseasesDB 2156 MedlinePlus 000433 eMedicine MeSH orthoped/455 pmr/21 emerg/83 radio/135 D002349

This article is about the medical condition. For the anatomical structure, see Carpal tunnel. For the Kid Koala album, see Carpal Tunnel Syndrome (album).

Carpal Tunnel Syndrome (CTS) is idiopathic median neuropathy at the carpal tunnel. The pathophysiology is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel.[1] The risk factors for CTS are primarily genetic rather than environmental.[2] The main symptom of CTS is intermittent numbness of the thumb, index, long and radial half of the ring finger.[3] The numbness usually occurs at night because we tend to sleep with our wrists flexed and is relieved by wearing a wrist splint that prevents flexion.[4] Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction.[5] There is a myth (in the sense of an unproved or false collective belief that is used to justify a social institution) that CTS manifests as pain with typing or other types of hand use.[6] Pain in carpal tunnel syndrome is primarily

numbness that is so intense that it wakes one from sleep. Pain in electrophysiologically verified CTS is associated with misinterpretation of nociception and depression.[7] Palliative treatments for CTS include use of night splints and corticosteroid injection. The only scientifically established disease modifying treatment is surgery to cut the transverse carpal ligament.[8] Carpal Tunnel Syndrome is considered by some to be a form of repetitive stress injury, and as such, is caused by repetitive motions, most famously from long hours of computer keyboard use. However, while studies have found associations between some work activities and Carpal Tunnel Syndrome, causality has not been demonstrated.[9]

• • • •

1 History 2 Anatomy 3 Symptoms 4 Causes
o o

4.1 Work related 4.2 Carpal tunnel syndrome associated with other diseases

• • • • •

5 Diagnosis 6 Prevalence 7 Prevention 8 Possible misdiagnosis 9 Treatment
o o o o

9.1 Immobilizing braces 9.2 Localized corticosteroid injections 9.3 Other medication 9.4 Carpal tunnel release surgery
 

9.4.1 Procedure 9.4.2 Efficacy

o o •

9.5 Ultrasound treatment 9.6 Physiotherapy and occupational therapy

10 Role of Occupational Therapy
o o

10.1 Assessment 10.2 Intervention

10.2.1 Education

10.2.2 Physical Symptom Management Techniques
  Splinting Other

10.2.3 Modifications for Prevention/Reduction of Symptoms
    Modification of Occupation (Task) Modification of Equipment and Tools Modification of Environment Summary

o o o o o

10.3 Long term recovery 10.4 Notable cases 10.5 See also 10.6 References 10.7 External links

[edit] History
The condition known as Carpal Tunnel Syndrome has had major appearances throughout the years but it was most commonly heard of in the years following World War II.[10] Individuals who had suffered from this condition have been depicted in surgical literature for the mid-19th century.[10] In 1854, Sir James Paget was the first to report median nerve compression at the wrist in a distal radius fracture.[11] Following the early 20th century there were various cases of median nerve compression underneath the transverse carpal ligament.[11] Carpal Tunnel Syndrome was most commonly noted in medical literature in the early 20th century but the first use of the term was noted 1939. Physician Dr. George S. Phalen of the Cleveland Clinic identified the pathology after working with a group of patients in the 1950s and 1960s.[12]

[edit] Anatomy
Main article: Carpal tunnel

The carpal tunnel is an anatomical compartment located at the base of the wrist. Nine flexor tendons and the median nerve pass through the carpal tunnel that is surrounded on three sides by the carpal bones that form an arch. The nerve and the tendons provide function, feeling, and movement to some of the fingers. The finger and wrist flexor muscles including their tendons originate in the forearm at the medial epicondyle of the elbow joint and attach to the Metaphalangeal (MP), Proximal Interphalangeal (PIP), and Distal Interphalangeal bones of the fingers and thumb (BSI). The carpal tunnel is approximately as wide as the thumb and its boundary lies at the distal wrist skin crease and extends distally into the palm for approximately 2 cm.[citation needed] The median nerve can be compressed by a decrease in the size of the canal, an increase in the size of the contents (such as the swelling of lubrication tissue around the flexor tendons), or both.[13] Simply flexing the wrist to 90 degrees will decrease the size of the canal. Compression of the median nerve as it runs deep to the transverse carpal ligament (TCL) causes atrophy of the thenar eminence, weakness of the flexor pollicis brevis, opponens pollicis, abductor pollicis brevis, as well as

Occupational risk factors of repetitive tasks. and extrinsic factors (pressure exerted from outside the tunnel).[17] [edit] Causes Most cases of CTS are of unknown causes.[19] Other causes of this condition include intrinsic factors that exert pressure within the tunnel. and vascular malformation. ganglion. force. which include benign tumors such as lipomas. diabetes. tingling. hypothyroidism. arthritis. Patients may also report pain in the arm and shoulder.sensory loss in the distribution of the median nerve distal to the transverse carpal ligament. and vibration have been cited. and it innervates the palm towards the thumb. the American Society for Surgery of the Hand (ASSH) has issued a statement that the current literature does not support a causal relationship between specific work activities and the development of diseases such as CTS.[14] [edit] Symptoms Untreated Carpal Tunnel Syndrome Patients with CTS experience numbness. Weakness and atrophy of the thenar muscles may occur if the condition remains untreated. or burning sensations in the thumb and fingers. or idiopathic. workers diagnosed with carpal tunnel syndrome are entitled to time off and compensation. which branches proximal to the TCL and travels superficial to it. There is a superficial sensory branch of the median nerve. in many locations.[21] In the USA Carpal tunnel syndrome results in an average of $30.[22] .[20] [edit] Work related The international debate regarding the relationship between CTS and repetitive motion in work is ongoing.[16] Numbness and paresthesias in the median nerve distribution are the hallmark neuropathic symptoms (NS) of carpal tunnel entrapment syndrome. The Occupational Safety and Health Administration (OSHA) has adopted rules and regulations regarding cumulative trauma disorders. posture. However. and radial half of the ring fingers which are innervated by the median nerve. particularly the index. [citation needed] The relationship between work and CTS is controversial.[18] Carpal Tunnel Syndrome can be associated with any condition that causes pressure on the median nerve at the wrist. This branch is therefore spared. Less specific symptoms may include pain in the hands or wrists and loss grip strength[15] (both of which are more characteristic of painful conditions such as arthritis). Some common conditions that can lead to CTS include obesity.000 in lifetime costs (medical bills and lost time from work). middle fingers. and trauma.

Colles' fracture. and the distinction from work related arm pains that are not carpal tunnel syndrome was not clear. in one recent representative series of a consecutive experience. It has also been proposed that postural and spinal assessment along with ergonomic assessments should be included in the overall determination of the condition. but inevitably progressive idiopathic peripheral mononeuropathy. This causes the soft tissues and bones around the carpel tunnel to grow causes compression of the median nerve. most patients were older and not working. It has also been stated that symptoms are commonly exacerbated by forceful and repetitive use of the hand and wrists in industrial occupations.[9] but it is unclear if this refers to pain (which may not be due to carpal tunnel syndrome) or the more typical numbness symptoms. reducing the amount of space. While addressing these factors has been found to improve comfort in some studies. amyloidosis.[27] Examples include: • • • • • Rheumatoid arthritis and other diseases that cause inflammation of the flexor tendons. diabetes mellitus. slowly. casues excessive growth hormones. During pregnancy women experience CTS due to hormonal changes and water retention which is common during pregnancy. particularly with a combination of forceful and repetitive activities [19] Acromegaly. size of the carpal tunnel. Many of these factors are manifestations of physiologic aging. Medical disorders that lead to fluid retention or are associated with inflammation such as: inflammatory arthritis. which swells the tenosynovium. associated local and systematic diseases and certain habits contribute to its etiology. but the weight of evidence suggests that this is an inherent. Obesity also increases the risk of CTS: individuals who are classified as obese (BMI > 29) are 2. can protrude into the carpal tunnel.[23] A review of available scientific data by the National Institute for Occupational Safety and Health (NIOSH) indicated that job tasks that involve highly repetitive manual acts or specific wrist postures were associated with incidents of CTS. CTS is found mostly in the working adult population.Some speculate that carpal tunnel syndrome is provoked by repetitive movement and manipulating activities and that the exposure can be cumulative. but causation was not established. genetic. Previous injuries including fractures of the wrist.[26] [edit] Carpal tunnel syndrome associated with other diseases A variety of patient factors can lead to CTS including heredity. or anywhere above the wrist. It has been proposed that repetitive use of the arm can affect the biomechanics of the upper limb or cause damage to tissues.[1] Non-traumatic causes generally happen over a period of time. hypothyroidism. and use of corticosteroids and estrogens. [28] Tumors (usually benign). such as a ganglion or a lipoma. Carpal tunnel syndrome is also associated with repetitive activities of the hand and wrist. but this seems untrue.5 times more likely than slender individuals (BMI < 20) to be diagnosed with CTS. acromegaly.[25] Based on the claimed increased incidence in the workplace. increases • • • • • .[24] The speculation or rationale that CTS is work related is based on debatable points such as: 1. fluid is retained in tissues. This may depend on how CTS is defined and diagnosed. With pregnancy and hypothyroidism. For instance. and are not triggered by one certain event. This is exceedingly rare (less than 1%). arm use is implicated. [29] Double crush syndrome is a debated hypothesis that compression or irritation of nerve branches contributing to the median nerve in the neck.

or applying firm pressure to the palm over the nerve for up to 30 seconds to elicit symptoms has also been proposed. though less sensitive test.[30] • • Heterozygous mutations in a gene. as in CTS. Only this test has been shown to correlate with CTS severity when studied prospectively.[36] Nerve conduction studies (NCS) are a sensitive measure of detecting compression of the median nerve..S. patients will sometimes be tested electrodiagnostically with nerve conduction studies and electromyography. but slightly more specific than Phalen’s sign. The quicker the numbness starts. There are many electrodiagnostic tests used to make a diagnosis of CTS. Tinel's sign (pain and/or paresthesias of the median-innervated fingers with percussion over the median nerve) is less sensitive. a very mild case of carpal tunnel syndrome. the more advanced the condition. Compression results in damage to the myelin sheath and manifests as delayed latencies and slowed conduction velocities [1] The role of MRI or ultrasound imaging in the diagnosis of carpal tunnel syndrome is unclear. Phalen's sign is defined as pain and/or paresthesias in the median-innervated fingers with one minute of wrist flexion. SH3TC2. [34][35] • • Other conditions may also be misdiagnosed as carpal tunnel syndrome. Electrodiagnosis rests upon demonstrating impaired median nerve conduction across the carpal tunnel in context of normal conduction elsewhere. There is little evidence. it will conduct more slowly than normal and more slowly than other nerves. if history and physical examination suggest CTS. however. carpal compression test. that this syndrome really exists. is a way to detect irritated nerves. • Phalen's maneuver is performed by flexing the wrist gently as far as possible. Caucasians have the highest risk of CTS compared with other races such as non-white South . Patients with intermittent numbness in the distribution of the median nerve along with positive Phalen's. but the most sensitive.[1] Durkan test. When the median nerve is compressed. [33] A positive test is one that results in numbness in the median nerve distribution when holding the wrist in acute flexion position within 60 seconds. Clinical assessment by history taking and physical examination can support a diagnosis of CTS.[37][38][39] [edit] Prevalence Carpal tunnel syndrome can affect anyone. Tinel's is performed by lightly tapping the skin over the flexor retinaculum to elicit a sensation of tingling or "pins and needles" in the nerve distribution. [31] Parvovirus b19 has been associated with carpel tunnel syndrome [32] [edit] Diagnosis The reference standard for the diagnosis of carpal tunnel syndrome is electrophysiological testing. specific and reliable test is the Combined Sensory Index (also known as Robinson index). a classic. confer susceptibility to neuropathy.sensitivity of the nerve to compression in the wrist. The goal of electrodiagnostic testing is to compare the speed of conduction in the median nerve with conduction in other nerves supplying the hand. Thus. roughly 1 out of 20 people will suffer from the effects of carpal tunnel syndrome. then holding this position and awaiting symptoms. Durkan's and eletrophysiological tests have at worst. In the U. [1] Tinel's sign. A predominance of pain rather than numbness is unlikely to be caused by carpal tunnel syndrome no matter what the result of electrophysiological testing. associated with Charcot-Marie-Tooth. including the carpal tunnel syndrome.

[41] and they stigmatize arm use in ways that risks increasing illness. When pain is the primary symptom. For instance. physiotherapy (preferable). activity modification. scientists have long abandoned the potential role of B-vitamins in carpal tunnel syndrome. MD who believe that carpal tunnel syndrome is simply a universal label applied to anyone suffering from pain.[40] [edit] Prevention A 2007 study. hypothyroidism. taking proper breaks. Otherwise. Simons. numbness.[44][45] [edit] Possible misdiagnosis There are some. and surgical release of the transverse carpal ligament. mouse pad). but there is little or no data to support these concepts. and/or burning in the radial side of the hands and/or wrists. Janet G. these recommendations have sufficient evidence for carpal tunnel syndrome when found in association with the following conditions: diabetes mellitus. carpal tunnel syndrome is probably not preventable. may include splinting or bracing. voice recognition and dictation) and early passive treatment like taking turmeric (antiinflammatory). practicing healthy work habits like using ergonomic equipment (wrist rest.[23] As a whole. the main recommended treatments are local corticosteroid injection. others[who?] think it can be prevented by developing healthy habits like avoiding repetitive stress. omega-3 fatty acids. and carpal tunnel syndrome in the workplace.Africans. Generally accepted treatments. According to the 2007 guidelines by the American Academy of Orthopaedic Surgeons. in the Department of Orthopaedic Surgery at Massachusetts General Hospital. Travell. pregnancy.[40] Women suffer more from CTS than men with a ratio of 3:1 between the ages of 45–60 years. such as Dr. as described below. steroid injection. The treatment should be switched when the current treatment fails to resolve the symptoms within 2 to 7 weeks.[47] [edit] Immobilizing braces .[47] early surgery with carpal tunnel release is indicated where there is clinical evidence of median nerve denervation or the patient elects to proceed directly to surgical treatment. polyneuropathy. swelling.[46] [edit] Treatment There have been numerous scientific papers evaluating treatment efficacy in CTS. using keyboard alternatives (digital pen. The persistence of such theories in spite of evidence to the contrary is remarkable. It is important to distinguish treatments that are supported in the scientific literature from those that are advocated by any particular device manufacturer or any other party with a vested financial interest. and B vitamins. chiropractic. rheumatoid arthritis. Only 10% of reported cases of CTS are younger than 30 years. medications. MD and Dr. oral corticosteroids and ultrasound treatment.[original research?] However. However. conducted by Lozano-Calderon et al. the medical community is not currently embracing or accepting trigger point theories due to lack of scientific evidence supporting their effectiveness.[42][43] Those who favor activity as a cause of carpal tunnel syndrome speculate that activity-limitation might limit the risk of developing carpal tunnel syndrome. carpal tunnel syndrome is unlikely to be the source of the symptoms.[41] Therefore. regular massage therapy treatments. coexistent cervical radiculopathy. states that carpal tunnel syndrome is primarily determined by genetics and structure. David G. splinting (immobilizing braces).

one should wear braces at night and.[48] Current recommendations generally don't suggest immobilizing braces. For most patients. an injection may also be of diagnostic value. The American Academy of Neurology recommend a non-invasive treatment for the CTS at the beginning (except for sensitive or motor deficit or grave report at EMG/ENG): a therapy using splints was indicated for light and moderate pathology.A rigid splint can keep the wrist straight. but instead activity modification and non-steroidal anti-inflammatory drugs as initial therapy. if possible.[49][50][51] Many health professionals suggest that. In general.[55] [edit] Other medication A more aggressive pharmaceutical option is an injection of cortisone. medical professionals prescribe local steroid injections only until other treatment options can be identified. followed by more aggressive options or specialist referral if symptoms do not improve. Methylcobalamin (vitamin B12) has been helpful in some cases of CTS.[52][53] [edit] Localized corticosteroid injections Corticosteroid injections can be quite effective for temporary relief from symptoms of CTS for a short time frame while a patient develops a longterm strategy that fits with his/her lifestyle. to reduce swelling and nerve pressure within the carpal tunnel. during the activity primarily causing stress on the wrists. [56] [edit] Carpal tunnel release surgery . In 1993. This treatment is not appropriate for extended periods. surgery is the only option that will provide permanent relief. for best results. The importance of wrist braces and splints in the carpal tunnel syndrome therapy is known. however.[54] In certain patients. but many people are unwilling to use braces.

the open technique resulted in more tenderness of the scar than the endoscopic method.[57] In general. and when night-splinting no longer controls intermittent symptoms..[61] However. in a line with the ring finger) it no longer presses down on the nerve inside. but severe cases are unrelenting symptomatically and are likely to result in surgical treatment. the goal is to divide the transverse carpal ligament in two. relieving the pressure. or atrophy. since the 1990s. randomized. The left scar is 6 weeks old.Scars from carpal tunnel release surgery. Single-portal endoscopic surgery is a safe and effective method . milder cases can be controlled for months to years.[citation needed] Endoscopic techniques involve one or two smaller incisions (less than half inch each) through which instrumentation is introduced including a synovial elevator. Brown et al. palm or wrist incision(s). the skin and subcutaneous tissue is divided. probes. from the scaphoid bone to the hamate bone and pisiform. Two different techniques were used. muscle weakness. the right scar is 2 weeks old. It forms the roof of the carpal tunnel. Most surgeons historically have performed the open procedure. knives. However. A prospective randomized study done in 2002 by Trumble revealed that good clinical outcomes and patient satisfaction are achieved more quickly with the endoscopic method. conducted a prospective. Through this incision. involving brief outpatient procedures. and ultimately the transverse carpal ligament. not just intermittent) numbness. widely considered to be the gold standard. a growing number of surgeons now offer endoscopic carpal tunnel release. followed by the palmar fascia. and an endoscope used to visualize the underside of the transverse carpal ligament. It is recommended when there is static (constant. a common sign of advanced CTS Carpal Tunnel Syndrome Operation Release of the transverse carpal ligament is known as "carpal tunnel release" surgery. All techniques have several things in common.[59] There are several carpal tunnel release surgery variations: each surgeon has differences of preference based on their personal beliefs and experience. and when the surgeon cuts across it (i. This is a wide ligament that runs across the hand.e. Also note the muscular atrophy of the thenar eminence in the left hand.[58] [edit] Procedure In carpal tunnel release surgery.[60] The endoscopic methods do not divide the subcutaneous tissues or the palmar fascia to the same degree as the open method does. multi-center study and found no significant differences between the two groups with regard to secondary quantitative outcome measurements. and cutting of the transverse carpal ligament.[citation needed] The two major types of surgery are open carpal tunnel release and endoscopic carpal tunnel release.[citation needed] Open surgery involves an incision on the palm about an inch or two in length.[citation needed] Many studies have been done to determine whether perceived benefits of a limited endoscopic or arthroscopic release are significant.

and a power of 1. it is monitored and expansion confirmed by direct or endoscopic visualization.[71] A treatment process may consist of 20 sessions of 15 minutes of ultrasound applied to the area over the carpal tunnel at a frequency of 1 MHz.0 W/cm2.[citation needed] Carpal tunnel surgery is usually performed by a hand surgeon. the role of ultrasound in the treatment of CTS is debatable and it should be considered an experimental treatment. and it should be noted that this surgery will only mitigate carpal tunnel syndrome. The University of Pittsburgh Journal Vol 17. Some neurosurgeons and general surgeons also perform the procedure.of treating carpal tunnel syndrome. and a longer time before the patients could return to work. and will not relieve symptoms with alternative causes. Thus. many studies have shown no effect.[citation needed] [edit] Ultrasound treatment Some claim that Ultrasound to the wrist gives significant improvement of symptoms in people with CTS. avoid cutting the transverse carpal ligament and maintain the biomechanics of the hand. However. Balloon Carpal Tunnelplasty is a technique that uses a minimally invasive balloon catheter director to access the carpal tunnel. It is considered to be the procedure of choice for many of these surgeons with respect to idiopathic carpal tunnel syndrome. MD.[69][70] Success is greatest in patients with the most typical symptoms. there has been broad support for either surgical procedure using a variety of devices or incisions. retracted his advocacy of the technique. Thomas J. Supporting this are the results of some of the previously mentioned series which cite no difference in the rate of complications for either method of surgery.[citation needed] Complications can occur. There was no significant difference in the rate of complications or the cost of surgery between the two groups. L. the open technique caused greater scar tenderness during the first three months after surgery. Recurrence is rare.[71] However.[62] Many surgeons have embraced limited incision methods. The director protects the median nerve and contents of the carpal tunnel. a former advocate of endoscopic carpal tunnel release. orthopaedic or plastic surgeon. Like a traditional tissue elevator/expander with Balloon Carpal Tunnelplasty the carpal ligament is elevated increasing the space in the carpal tunnel. The Balloon Carpal Tunnelplasty technique is performed through a one centimeter incision at the distal wrist crease. some surgeons have suggested that in their own hands endoscopic carpal tunnel release has been associated with a higher incidence of median nerve injury. ref:Berger.[72][73] Given these inconsistencies. and for this reason it has been abandoned at several centers in the United States. Up to 90% of patients were able to return to their same jobs after surgery. The most common cause of failure is incorrect diagnosis. endoscopic techniques are as effective as traditional open carpal surgeries.[63] Despite these views. based on his assessment that the benefit of the procedure (slightly faster recovery) did not outweigh the risk of injury to the median nerve. thereby decompressing the median nerve.[64][65][66] In general. The primary goal of any carpal tunnel release surgery is to divide the transverse carpal ligament and the distal aspect of the volar ante brachial fascia. pg 80. [edit] Physiotherapy and occupational therapy . 2006 [edit] Efficacy Surgery to correct carpal tunnel syndrome has a high success rate. “Balloon Carpal Tunnelplasty. First Comparative Clinical Study”. At the 2007 meeting of the American Society for Surgery of the Hand. but serious ones are infrequent to rare. [67][68] though the faster recovery time typically noted in endoscopic procedures is felt by some to possibly be offset by higher complication rates. Fischer. The purpose of Balloon Carpal Tunnelplasty is to avoid an incision in the palm of the hand. and apparent recurrence usually results from a misdiagnosis of another problem.

a positive sign is indicated by numbness. Tinel’s sign involves tapping at the volar wrist while Phalen’s test involves maintaining wrist flexion for 60 seconds.[78] [edit] Intervention OTs provide protective and corrective non-surgical measures for CTS and focus intervention on the person's physical abilities.[78] The OT may perform a detailed step-by-step breakdown of what's involved in the activity to look at the specific tasks that could be affected by or be contributing to CTS symptoms. The OT may also observe the environment in which the activity is being performed and identify risk factors and compensatory strategies. for example. involve adopting a more ergonomic work and life environment. environment. and yoga for people with carpal tunnel syndrome. carpal bone mobilization. The OT may find. that repetitive lifting of heavy skillets is a contributing factor to the individual’s CTS symptoms. some claim that pro-active ways to reduce stress on the wrists. however some meta-analyses of these studies claim that the evidence that they present is limited. They may be administered by an occupational therapist (OT). In both tests. tingling or pain in the thumb. the OT may perform manual muscle testing for grip and pinch strength and assess range of motion.[75] Again. nerve gliding exercises. a recent evidence based guideline produced by the American Academy of Orthopedic Surgeons assigned lower grades to most of these treatments. OT intervention has an emphasis on enabling function in . One review of the evidence for possible symptom reduction found good evidence (level B recommendations) for splinting. some have claimed that switching from a QWERTY computer keyboard layout to a more optimised ergonomic layout such as Dvorak was commonly cited as beneficial in early CTS studies. For example. Following positive signs. and the activities they engage in. index and half of the middle finger.[74] However. For example.[76][77] [edit] Role of Occupational Therapy [edit] Assessment Tinel’s sign and Phalen’s tests can be used to assess for CTS. magnetic therapy.Typical physiotherapy exercise for carpal tunnel syndrome. the OT may analyze the activity of cooking. ultrasound. which alleviates wrist pain and strain.

self-care activities. including equipment and tools used. p983) .[83] Restricting wrist motion eliminates the repetitive movement and tension overload in the carpal tunnel.[84] This gives the tendon sheaths a chance to heal.[84] Splints also aim to keep the wrist at a certain angle to decrease pressure within the carpal tunnel. Splints may be pre-fabricated or customt-fit. and the setting in which it is being performed. Education may be provided to an individual client or a group of people.”([86]. At the levels of environment and occupation. back (dorsal) or outer side (pinky) of the arm. Prefabricated splints may be used but the fit may not be precise enough for all individuals. [85] the authors of a systematic review on non surgical carpal tunnel treatments conclude that “there is limited evidence that the use of a wrist splint in neutral position is more effective than an extended wrist position of 20 degrees in patients with CTS in the short term. OTs who provide intervention for individuals with CTS may also be hand therapists. which then may decrease the pressure on the median nerve. an individual must be a physical or occupational therapist with at least 5 years experience. Prefabricated splints are sold in health care supply stores and are an inexpensive option for clients.[80] A OT will fabricate a custom-fit splint by molding thermoplastic material unique to the client's hand. OTs provide education and modifications related to the method of task completion. reducing swelling. including 2000 hours of therapy pertaining directly to hands. and a certification exam is required.[81] Dorsal splints are also recommended for CTS as they reduce pressure placed on the volar wrist.[82] Although there has been debate about the best angle for wrist immobilization. In this case.[82] Splints aim to immobilize the wrist to decrease pressure in the carpal tunnel. Individuals with CTS or at risk for CTS may benefit from education in the areas outlined below: • • • • • • • • signs & symptoms of CTS options for treatment: surgical and/or non surgical interventions how to reduce risks & decrease symptoms of CTS splint wearing regimen body mechanics & exercises task adaptation adaptive tools workplace adaptations [edit] Physical Symptom Management Techniques [edit] Splinting OTs often use wrist splinting as a form of treatment. wrist and forearm. occupational therapists can provide education and/or direct intervention for physical symptom treatment and management. According to Muller et al’s systematic review on interventions for CTS.[79] [edit] Education OTs play a large role as educators. Splints can be based on the front (palmar). leisure and paid or unpaid work. a custom fit splint is required. At the level of person. Bash & Farber state that to become a hand therapist. volar cock-up splints and ulnar gutter splints are similar in their improvement of symptoms and function.

These tools were designed to reduce risk factors associated with cumulative trauma disorders such as CTS. [86] ) [edit] Modifications for Prevention/Reduction of Symptoms [edit] Modification of Occupation (Task) Modification of a task is about adjusting behaviors and actions that may contribute to the development or exacerbation of CTS. [89] A review of the literature has found evidence supporting the use of exercise and/or rest breaks in reducing musculoskeletal discomfort during computer work.[87] [edit] Other An occupational or physiotherapist working as a hand therapist may be involved in other areas of treatment for the symptoms of CTS depending on their scope of practice. For example. and corrected the positioning of the hand through specially shaped handles that did not impinge on the median nerve area of the palm. Specific risk factors that can contribute to CTS such as vibration can be reduced by introducing new tools with lower vibration levels as well as anti-vibration gloves. or nerve gliding exercises. low level-laser therapy. tasks can be redesigned to include diversity and thus limit repetitive movements that can aggravate CTS.([81]. Muller et al found that wearing a nocturnal splint as well as wearing a splint during aggravating activities alleviate symptoms of CTS (numbness. distributed the force over a larger surface area of the hand.[81] These treatments may include but are not limited to ultrasound.g. As Doheny et al suggest. alternative methods can be negotiated or discussed with the client. Two of these modifications included limiting repetitive tasks and decreasing work time.[90] Faucett et al found that people with CTS were more likely to continue with their current jobs if modifications were made to the tasks. pain and tingling) better than no treatment.[81] It follows that decreasing symptoms of CTS improves overall occupational function in activity.[91] OT's can provide recommendations on job modifications to reduce risk factors by modifying client's work tasks. electromagnetic field therapy. Once a task is analyzed. One such adaptation is increasing the diameter of handles so that less grip strength is needed to grasp an object. keep it in a more neutral position) and reduce the hand force required to complete an action. the OT will conduct an activity analysis to identify areas where change may be needed. magnetic therapy. Dolby Laboratories introduced hand tools that reduced the hand force required.[88] For example. Modifying equipment and tools can correct positioning of the hand (e. someone who has CTS may have difficulty holding their toothbrush or utensils while eating. Adaptive aids can be useful in enabling individuals with CTS to participate in their chosen activities. specialized spring-loaded pliers reduced the force required to cut wire for electronic assembly purposes. . As part of the assessment. For example.[92] For example. When modifying an environment. OTs can easily adapt these tools or purchase already adapted tools for a client.[93] Any handle can be built up in this way.In another systematic review on interventions for CTS.[94] [edit] Modification of Environment Another important avenue of occupational therapy is adapting the environment to facilitate occupational performance of a particular task. This study also suggests minimizing wrist extension through appropriate body posture at the workstation which may help to reduce carpal tunnel pressure. often the equipment and tool adaptations are part of that environmental change. [edit] Modification of Equipment and Tools A major role of OTs is to introduce modified equipment and adaptive aids to enable occupational performance despite physical limitations. Keir et al suggest breaking up the repetitive action of using a computer mouse with other tasks because mouse use was shown to increase carpal tunnel pressure.

[88] For example. such that the carpal tunnel release has had no positive effect upon the patient's symptoms. While outcomes are generally good. such as job demands and job control.e. the ideal position of the wrist and forearm can be achieved. The hand therapists in this study used the following intervention strategies and reported symptom relief: • • • • • made ergonomic changes to the work station (modify environment) used adaptive scissors and shears (modify tools/equipment) reheated splint material to trim edges (modify task) changed hand position (modify task) used assistive equipment for scar massage (modify tools/equipment) [79] [edit] Summary In summary. tools and environments as part of their own intervention plan. or surgery type. certain factors can contribute to poorer results that have little to do with nerves. alcohol use.[79] Hand therapists are an example of a population that has been found to have high instances of CTS due to repetitive. there is moderate evidence that a modified ergonomic keyboard is more effective than a regular keyboard at relieving symptoms of CTS. as they may help or hinder return to work and level of functioning within the workplace for those individuals with CTS. anatomy. By adjusting the workstation equipment. it is most likely not caused by carpal tunnel syndrome. These authors found that many hand therapists with symptoms of CTS not only wore splints. [edit] Long term recovery Most people who find relief of their carpal tunnel symptoms with conservative or surgical management find minimal residual or "nerve damage".[96] Long-term chronic carpal tunnel syndrome (typically seen in the elderly) can result in permanent "nerve damage".In the management of CTS. It may be the case that the illness of a person who has hand pain after carpal tunnel release was diagnosed incorrectly. The interventions for CTS mentioned above can be used together as illustrated in a study by Bash and Farber. chairs. symptom management techniques such as splinting. equipment and the environment.[95] Similar to the work environment. monitors. yield much poorer overall results of treatment. i. Within the area of intervention.[98] If a person has hand pain after surgery.e.[89] Attention should also be given to psychosocial aspects of a work environment. stressful movements on the job. OTs can help adapt the home environment through the introduction of adaptive aids and adjustment of furniture or equipment. and keyboards. such as desks. and modification of specific tasks. adapting the work environment) is a large part of OT intervention. muscle wasting and weakness. One study showed that mental status parameters. OTs are involved in the assessment and intervention process with clients with CTS.[97] Recurrence of carpal tunnel syndrome after successful surgery is rare. This can help alleviate symptoms of CTS as well as prevent further damage and strain. . irreversible numbness. workstation modification (i. OTs provide education. but also engaged in modifying their tasks.[86] The addition of forearm supports can help to facilitate appropriate posture of the wrist by preventing extension while using a mouse.

Most likely the disorder is due to a congenital predisposition . the muscles at the base of the thumb may waste away. rather than a problem with the nerve itself. a painful progressive condition caused by compression of a key nerve in the wrist.htm You're working at your desk.the carpal tunnel is simply smaller in some people than in others. fluid retention during pregnancy or menopause. The symptoms often first appear in one or both hands during the night. weakness. radiating up the arm. people might feel tingling during the day. In some cases no cause can be identified. which runs from the forearm into the hand. piercing pain shoots through the wrist and up your arm. trying to ignore the tingling or numbness you've had for months in your hand and wrist.a narrow. hypothyroidism. top What are the symptoms of carpal tunnel syndrome? Symptoms usually start gradually. Just a passing cramp? More likely you have carpal tunnel syndrome.houses the median nerve and tendons.http://www.ninds. even though little or no swelling is apparent. or itching numbness in the palm of the hand and the fingers. Sometimes. Other contributing factors include trauma or injury to the wrist that cause swelling. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger). mechanical problems in the wrist joint. a sharp. In chronic and/or untreated cases. Some people are unable to tell between hot and cold by touch. or perform other manual tasks. thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. Some carpal tunnel sufferers say their fingers feel useless and work stress. repeated use of vibrating hand tools. carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatized. since many people sleep with flexed wrists. rheumatoid arthritis. As symptoms worsen. with frequent burning. tingling. Suddenly. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. overactivity of the pituitary gland. or the development of a cyst or tumor in the canal. top What is carpal tunnel syndrome? Carpal tunnel syndrome occurs when the median nerve. especially the thumb and the index and middle fingers. top What are the causes of carpal tunnel syndrome? Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel. becomes pressed or squeezed at the wrist. Although painful sensations may indicate other conditions. The result may be pain. such as sprain or fracture. rigid passageway of ligament and bones at the base of the hand . or numbness in the hand and wrist. . The carpal tunnel . Decreased grip strength may make it difficult to form a fist. grasp small objects.nih. as well as impulses to some small muscles in the hand that allow the fingers and thumb to move.

test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. and meat. Persons with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk. swelling. Writer's cramp . Small electric shocks are applied and the speed with which nerves . wrist. perhaps because the carpal tunnel itself may be smaller in women than in men. poultry. Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. A physical examination of the hands. and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder. not a symptom of carpal tunnel syndrome. arthritis. including medical bills and lost time from work. and discoloration. such as tingling or increasing numbness. The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job.000 workers lost time from work because of carpal tunnel syndrome.manufacturing. an estimated three of every 10. top How is carpal tunnel syndrome diagnosed? Early diagnosis and treatment are important to avoid permanent damage to the median nerve. In a nerve conduction study.a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers. Doctors may also ask patients to try to make a movement that brings on symptoms. In the Tinel test. During 1998. but is especially common in those performing assembly line work . Each finger should be tested for sensation. The wrist is examined for tenderness. In fact. is estimated to be about $30. shoulders. The average lifetime cost of carpal tunnel syndrome. or wrist-flexion. The Phalen. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis. Carpal tunnel syndrome usually occurs only in adults. finishing. and fractures. Routine laboratory tests and X-rays can reveal diabetes. arms. the doctor taps on or presses on the median nerve in the patient's wrist. carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. or fish packing. A 2001 study by the Mayo Clinic found heavy computer use (up to 7 hours a day) did not increase a person's risk of developing carpal tunnel syndrome. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. is felt in the fingers within 1 minute. or forearm is brought on by repetitive activity . and can rule out other painful conditions that mimic carpal tunnel syndrome. The dominant hand is usually affected first and produces the most severe pain. Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. and the muscles at the base of the hand should be examined for strength and signs of atrophy. The presence of carpal tunnel syndrome is suggested if one or more symptoms. electrodes are placed on the hand and wrist.There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. sewing. cleaning. top Who is at risk of developing carpal tunnel syndrome? Women are three times more likely than men to develop carpal tunnel syndrome. Half of these workers missed more than 10 days of work.000 for each injured worker.

Ultrasound imaging can show impaired movement of the median nerve. In electromyography. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate. Alternative therapies . Nonsteroidal anti-inflammatory drugs. These exercises may be supervised by a physical therapist. electrical activity viewed on a screen can determine the severity of damage to the median nerve. various drugs can ease the pain and swelling associated with carpal tunnel syndrome.transmit impulses is measured. temporary relief to persons with mild or intermittent symptoms. under a doctor's direction. Surgery is done under local anesthesia and does not require an overnight hospital stay. the traditional procedure used to correct carpal tunnel syndrome.In special circumstances. which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome. consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. avoiding activities that may worsen symptoms. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. If there is inflammation. . who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being. Surgery Carpal tunnel release is one of the most common surgical procedures in the United States. applying cool packs can help reduce swelling. who is trained to use exercises to treat physical impairments. top How is carpal tunnel syndrome treated? Treatments for carpal tunnel syndrome should begin as early as possible.Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. such as aspirin. An exception is yoga. Corticosterioids should not be taken without a doctor's prescription. may ease symptoms that have been present for a short time or have been caused by strenuous activity. a fine needle is inserted into a muscle. Underlying causes such as diabetes or arthritis should be treated first. The following are types of carpal tunnel release surgery: Open release surgery. Many patients require surgery on both hands. The procedure is generally done under local anesthesia on an outpatient basis. some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome. ibuprofen. Generally recommended if symptoms last for 6 months. or an occupational therapist. and immobilizing the wrist in a splint to avoid further damage from twisting or bending. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome. Non-surgical treatments Drugs . Orally administered diuretics ("water pills") can decrease swelling. and other nonprescription pain relievers. Exercise .) Additionally. unless there are unusual medical considerations. surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve.Stretching and strengthening exercises can be helpful in people whose symptoms have abated.

tools and tool handles. perform stretching exercises. such as specific joint angles. a part of the National Institutes of Health. and cuts the carpal ligament (the tissue that holds joints together). Employers can develop programs in ergonomics. Although symptoms may be relieved immediately after surgery. if any. Single portal endoscopic surgery for carpal tunnel syndrome is also available and can result in less post-operative pain and a minimal scar. Recurrence of carpal tunnel syndrome following treatment is rare. nerve damage. and use correct posture and wrist position. including carpal tunnel syndrome. and progression over time. inserts a camera attached to a tube. motions. observes the tissue on a screen. Data to be collected from a National Institute for Occupational Safety and Health-sponsored study of carpal tunnel syndrome among construction workers will provide a better understanding of the specific work factors associated with the disorder. take frequent rest breaks. research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome. workers can do on-the-job conditioning. stiffness. Randomized clinical trials are being designed to evaluate the effectiveness of educational interventions in reducing the incidence of carpal tunnel syndrome and upper extremity cumulative trauma disorders. Some patients may have infection. Patients should undergo physical therapy after surgery to restore wrist strength. and assist in developing strategies to prevent its occurrence among construction and other workers. Workstations. top How can carpal tunnel syndrome be prevented? At the workplace. By determining distinct biomechanical factors related to pain. Some patients may need to adjust job duties or even change jobs after recovery from surgery. treat. The surgeon makes two incisions (about ½" each) in the wrist and palm. The majority of patients recover completely. force. top What research is being done? The National Institute of Neurological Disorders and Stroke (NINDS). furnish pilot data for planning future projects to study its natural history. the process of adapting workplace conditions and job demands to the capabilities of workers. is the federal government's leading supporter of biomedical research on neuropathy.Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. is effective and minimizes scarring and scar tenderness. and tasks can be redesigned to enable the worker's wrist to maintain a natural position during work. It generally allows individuals to resume some normal activities in a short period of time. and pain at the scar. This twoportal endoscopic surgery. researchers are finding new ways to limit or prevent carpal tunnel syndrome in the workplace and decrease other costly and disabling occupational illnesses. Scientists are studying the chronology of events that occur with carpal tunnel syndrome in order to better understand. and prevent this ailment. However. full recovery from carpal tunnel surgery can take months. wear splints to keep wrists straight. Wearing fingerless gloves can help keep hands warm and flexible. Jobs can be rotated among workers. Other research will discern differences between the relatively new carpal compression test (in which the examiner applies moderate pressure with both thumbs directly . Occasionally the wrist loses strength because the carpal ligament is cut. generally performed under local anesthesia.

http://www. such as acupuncture. to prevent and treat this disorder. followed by direct pressure on the median nerve) in predicting carpal tunnel the carpal tunnel and underlying median nerve. at the transverse carpal ligament) and the pressure provocative test (in which a cuff placed at the anterior of the carpal tunnel is inflated.womenshealth.pdf . Scientists are also investigating the use of alternative therapies.

many people sleep with their wrist bent. Thumb muscles can actually waste away over time. Although there is limited research on why this is the case. It may be that the wrist bones are naturally smaller in most women. Sometimes swelling and irritation of the tendons can put pressure on the wrist nerve causing the symptoms of CTS. Tendons and a nerve called the median nerve must pass through this tunnel from your forearm into your hand. Department of Labor reported that in 2003 the average number of missed days of work due to CTS was 23 days. costing over $2 billion a year. Then. These are some of the things that might raise your chances of developing CTS: • Genetic predisposition. index and middle fingers. nearly half of CTS sufferers have symptoms in both hands. The areas most affected are the thumb.S. creating a tighter space through which the nerves and tendons must pass. in some cases. The U. At first.If left untreated. Other researchers are looking at genetic links that make it more likely for women to have muscu-loskeletal injuries such as CTS. Q: What causes CTS and who is more likely to develop it? A: Women are three times more likely to have CTS than men. CTS has become more common in the U. CTS begins slowly with feelings of burning. A person’s dominant hand is the one that is usually affected. As CTS gets worse. which may cause more pain and symptoms at night. those with CTS can have a loss of feeling in some fingers and permanent weakness of the thumb. pain. Your wrist is made of small bones that form a narrow groove or carpal tunnel. and is quite costly in terms of time lost from work and expensive medical treatment.S.7 percent of the general public in this country suffer from CTS. the tingling may be felt during the daytime too. make a fist. and numbness in the wrist and hand. the cause is unknown. symptoms may happen more often at night. There are other factors that can cause CTS. People who do the same movements with their wrists and hands over and over may be more likely to develop CTS. Eventually. or hold onto something small. along with pain moving from the wrist to your arm or down to your fingers. including certain health problems and. People with certain types of jobs are more likely . The carpal tunnel is smaller in some people than others. Many CTS sufferers do not make the connection between a daytime activity that might be causing the CTS and the delayed symptoms.Carpal TunnelSyndrome Q: What is carpal tunnel syndrome (CTS)? A: Carpal tunnel syndrome (CTS) is the name for a group of problems that includes swelling. Also. The median nerve controls the feelings and sensations in the palm side of your thumb and fingers. women are at higher risk of CTS between the ages of 45 and 54. scientists have several ideas. Generally. Pain is usually felt more on the palm side of the hand. the risk increases for both men and women as they age. this feeling will usually happen more often. The fingers may even feel like they are swollen even though they are not. tingling. tingling. and loss of strength in your wrist and hand. Women also deal with strong hormonal changes during pregnancy and menopause that make them more likely to suffer from CTS. However. Q: What are the symptoms of CTS? A: Typically. It is thought that about 3. CTS sufferers may have trouble telling the difference between hot and cold temperatures by touch. Some people with CTS find it difficult to grasp an object. Over time. • Repetitive Movements.Another symptom of CTS is weakness of the hands that gets worse over time.

the wrist structures become enlarged and can press on the wrist nerve. smokers with CTS usually have worse symptoms and recover more slowly than nonsmokers. such as golfing. • Injury or Trauma. Left untreated. Most doctors treat CTS in pregnant women with wrist splits or rest. People who have diabetes. and gardening. Some women who have a mastectomy get lymphedema. such as strong vibrations caused by heavy machinery or power tools. Over time. Some hobbies and sports that use repetitive hand movements can also cause CTS. but more research is needed. this causes pain and swelling of the arm. • Menopause. CTS can cause nerve damage that leads to loss of feeling and less hand strength. knitting. increasing the risk of CTS. have CTS. the normal structures in the wrist can become enlarged and lead to CTS. as CTS almost always goes away following childbirth. In some of these patients. and rheumatoid arthritis are more likely to get CTS. the build-up of fluids that go beyond the lymph system's ability to drain it. Hormonal changes during pregnancy and build up of fluid can put pregnant women at greater risk of getting CTS. Limited research points to a weak link. Hormonal changes during menopause can put women at greater risk of getting CTS. • Pregnancy. Also. rather than surgery. Forceful and stressful movements of the hand and wrist can also cause trauma. Also. In mastectomy patients. violinists. Q: How is CTS treated? A: It is important to be treated by a doctor for CTS in order to avoid permanent damage to the wrist nerve and muscles of the hand and thumb. obesity. especially during the last few months. . and carpenters. some of these women will get CTS due to pressure on the nerve from this swelling. Whether or not long-term typing or computer use causes CTS is still being debated. in some postmenopausal women. including manufacturing and assembly line workers. hypothyroidism. A sprain or a fracture of the wrist can cause swelling and pressure on the nerve. grocery store checkers. Underlying causes such as diabetes or a thyroid problem should be addressed first. Although rare. • Breast Cancer. • Medical Conditions.

chiropractic manipulation. A physical therapist can help you do special exercises to make your wrist and hand stronger. Permanent injury occurs in about 1 percent of those with CTS. • Medication. an injection of cortisone may help to reduce swelling. Treatments for CTS include the following: • Wrist Splint. Scientists are also researching better ways to detect and treat CTS. . Massage. surgery is only an option for severe cases of CTS and/or after other treatments have failed for a period of at least six months. NSAIDs include aspirin. ultrasound. If CTS is caused by another health problem. You can even lose the ability to feel hot and cold by touch. A splint can be worn 24 hours a day or only at night. The National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) support research on work-related factors that may cause CTS. your doctor will probably treat that problem first. stopping or doing less of a repetitive movement may be all that is needed.the muscles of the thumb can become weak and damaged. The short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful to control CTS pain. There are also many different kinds of treatments that can make CTS better and help relieve symptoms. Your doctor may also give you corticosteroids in a pill form. CTS is much easier to treat early on. and acupuncture are just a few such options that have been found to be helpful. Splinting can work the best when done within three months of having any symptoms of CTS. Generally. If you have diabetes. these treatments only relieve symptoms temporarily. This surgery is done under a local anesthetic to numb the wrist and hand area and is an outpatient procedure. CTS surgery is one of the most common surgeries done in the U. For people with mild CTS. ibuprofen. yoga. and other non-prescription pain relievers. Open release surgery is a common approach to CTS surgery and involves making a small incision in the wrist or palm and cutting the ligament to enlarge the carpal tunnel. Q: What is the best way to prevent CTS? A: Current research is focused on figuring out what causes CTS and how to prevent it. Your doctor will likely talk to you about steps that you should take to prevent CTS from coming back. In severe cases. • Physical Therapy. • Surgery. it is important to know that long-term corticosteroid use can make it hard to control insulin levels. Most CTS patients get better after first-step treatments and the following tips for protecting the wrist. You should talk with your doctor before trying these alternative treatments. wearing a splint at night helps to reduce the pain. Sometimes.S. • Rest. including alternative treatments such as acupuncture. But. A splint can be worn to support and brace your wrist in a neutral position so that the nerves and tendons can recover.

Practice doing hand and wrist motion tasks more gently and less tightly. This causes the pain. http://www.niams. it is helpful to make a tight fist and hold it for a second. Any swelling in this “tunnel” causes the nerve to become pinched. Sometimes. If you are working on a computer.nih.nih.pdf Carpal tunnel syndrome is a common condition that affects the wrist and hand. It goes through a passage in the wrist bones called the carpal tunnel (see diagram below).ninds.For more information on research. For example. Break up tasks that require repetitive wrist and hand motion with those that do not. after typing with your wrist and hand extended. It occurs when too much pressure is put on the median nerve. Experts believe that taking a 10 to 15 minute break every hour is a good way to prevent CTS. you can sometimes cancel out the effects of those movements by flexing and bending your wrists and hands in the opposite direction.upmc. the symptoms may get worse. After doing repetitive movements for a while. Try repeating this several times. and tingling related to carpal tunnel syndrome. • Relax Your Grip. Allowing your hand and wrist to rest and recover every so often will lower your risk of swelling. • Stay Warm. Stress and tension play a role in muscle strain and or call 1-800-352-9424 • NIAMS at http://www. . then stretch out the fingers and hold for a few • Do exercises. Try to do tasks that use different muscle movements during each hour. • Vary Tasks. the keyboard should be at a height that allows your wrist to rest comfortably without having to bend at an angle. Desk or table workspace should be about 27 to 29 inches above the floor for most people. numbness. • Take Breaks. It is important to keep your hands warm while you work. It also helps to keep your elbows close to your sides as you type to reduce the strain on your forearm. The median nerve runs through the wrist to the hand and fingers. Avoid repetitive movements without changing up your routine. If the pressure is not relieved. contact: • NINDS at http://www. Make sure that your workspace and equipment are at the right height and distance for your hands and wrist to work with less strain. Keeping good posture and wrist position can lower your risk of getting CTS. even if you must wear fingerless gloves. people get into a habit of tensing muscles without needing or call 1-301-496-8190 or 1-877-226-4267 The following steps can help to prevent CTS: • Prevent workplace musculoskeletal injury. Muscles that are warm are less likely to get hurt and the risk of getting CTS is greater in a cold environment.

As swelling in the carpal tunnel goes down. Hand and wrist exercises. Steroids are medicines that can be injected into the wrist area to help bring down the swelling in the carpal tunnel. Your doctor will check you and decide what treatments would be most helpful to you.Carpal tunnel syndrome may occur after a wrist fracture or injury that causes swelling. Wrist splints help to reduce pressure by keeping your wrist in a relaxed position. tingling. This puts more pressure on the median nerve. Your doctor may prescribe medicine to help reduce swelling. • Medicine to reduce swelling. What are the symptoms of carpal tunnel syndrome? • pain. which usually starts in the hand but may travel up the arm to the shoulder • numbness. kidney disease. • Surgery Carpal tunnel release surgery Carpal tunnel release is an operation done to relieve the pressure on the median nerve. there is less pressure on the median nerve. or the feeling of “pins and needles” in the hand or fingers • burning feeling in the hand or fingers • tenderness in the wrist area • swelling in the wrist area • weakness or loss of strength in the hand How is carpal tunnel syndrome treated? Treatment depends on how bad your symptoms are. Moving your hand and wrist up or down narrows the space in the carpal tunnel. such as diabetes. Treatments for carpal tunnel include: • Wrist splints. Others protect the wrist during work or other activities. pressure is relieved from the median nerve. When there is less swelling. Usually people having this operation come in . These exercises are prescribed by your doctor or a physical or occupational therapist. • Medicine injected into the wrist area. Your doctor or therapist may prescribe wrist splints. or pregnancy. It also can occur with certain conditions that cause fluid to build up. Some splints are worn only at night.

• Activity. Your doctor may prescribe pain medicine and an antibiotic after surgery. which affects only the area of your wrist. The surgery usually is done using a local anesthetic. when they exist. The operation usually takes about an A ligament called the carpal transverse ligament is divided. Do not lift anything with the hand you had surgery on until your doctor says it’s OK.for surgery and go home that same day. This incision is usually on the palm side of your hand in the wrist area (see diagram below). Your doctor will remove the stitches under the dressing. keep the dressing over your incision clean and dry until your follow-up appointment with your doctor. After surgery • Medicine. relieving pressure on the median nerve. a small cut (incision) is made. Evidence supporting various strategies is then presented. This means you won’t go to sleep for this operation.nejm. Be sure to move your fingers regularly. Unless instructed otherwise. During the operation. When to call the doctor Call your doctor if any of the following occur: • an increase in pain not relieved by pain medicine • an increase in swelling not relieved by elevating your hand • a large increase in the amount of drainage on your dressing • an increase in the feeling of coolness or color changes in your fingers or fingertips • a foul smell from the dressing • chills or fever of 101 F or above Follow-up appointment: http://www. followed by a review of formal guidelines. . This opens up the carpal tunnel. Be sure to take these as directed. This helps to reduce swelling and pain. • Elevation. The article ends with the authors' clinical recommendations. This will keep them from getting stiff and help lessen the swelling. • Dressing.1056/NEJMcp013018 This Journal feature begins with a case vignette highlighting a common clinical problem. It’s important to keep your hand raised above the level of your heart as much as possible for the first 48 hours following surgery.

12 Strategies and Evidence . and use of corticosteroids and estrogens. with peak prevalence in women older than 55 years of age.6 Carpal tunnel syndrome is also associated with repetitive activities of the hand and wrist. axonal injury ensues. finger.4 A variety of conditions may be associated with carpal tunnel syndrome. Colles' fracture.2 The carpal tunnel (Figure 1Figure 1 The Anatomy of the Carpal Tunnel. and construction work. tingling. about 6 percent of patients have diabetes. entrapment of the ulnar nerve. symptomatic carpal tunnel syndrome is about 3 percent among women and 2 percent among men. It is bounded on three sides by the carpal bones. diabetes mellitus. These include pregnancy. particularly with a combination of forceful and repetitive activities. The prevalence of electrophysiologically confirmed. the prevalence of carpal-tunnel symptoms diminishes.11 The natural history of carpal tunnel syndrome is variable. and burning pain in the three radial digits of both hands. although abnormalities of nerve conduction tend to worsen over time. She has no atrophy of the thenar muscles. Sensation to light touch is intact. and nerve dysfunction may be irreversible. this increased pressure produces ischemia of the median nerve. retired woman presents with intermittent numbness. Nine flexor tendons (two extending to each finger and one to the thumb) traverse the carpal tunnel. and on the palmar side by the fibrous flexor retinaculum. One 11-year study of workers with carpal tunnel syndrome showed that. amyloidosis. When there is prolonged ischemia.7 million office visits to physicians for new problems per year in the United States. and cervical radiculopathy). Early in the course.A 64-year-old. occasionally with weakness.3.5. and they awaken her several times each night. hypothyroidism. or wrist symptoms account for 2. inflammatory arthritis.6 Up to one third of cases of carpal tunnel syndrome occur in association with such medical conditions7. no morphologic changes are observable in the median nerve.) is located at the base of the palm. tendon disorders. manufacturing.1 The differential diagnosis of discomfort of the hand and wrist includes entrapments of the nerves (such as carpal tunnel syndrome. or transverse carpal ligament. logging.8. along with the median nerve. She has had these symptoms for three months.8-10 Occupations associated with a high incidence of carpal tunnel syndrome include food processing. just distal to the distal wrist crease. Prolonged or frequent episodes of elevated pressure in the carpal tunnel may result in segmental demyelination and more constant and severe symptoms. right-handed. overuse of muscles. and symptoms are intermittent. acromegaly. and less common disorders. Carpal tunnel syndrome is caused by elevated pressure in the carpal tunnel3. neurologic findings are reversible. How should she be evaluated and treated? The Clinical Problem Hand. nonspecific pain syndromes. which create an arch. resulting in impaired nerve conduction and attendant paresthesia and pain.

” had both a sensitivity and a specificity that exceeded 90 percent in one study.21. both symptoms and electrodiagnostic studies must be interpreted carefully.17.19 Often.22. This response.17. index finger.19. the patient reports whether flexion of the wrist for 60 seconds elicits pain or paresthesia in the median-nerve distribution. Both tests are deemed positive if they elicit radiating paresthesia in the median-nerve distribution.17 The sensitivity was lower and the specificity higher when the diagram was used to screen workers for carpal tunnel syndrome.24 Tinel's sign is judged to be present if tapping lightly over the volar surface of the wrist causes radiating paresthesia in the digits innervated by the median nerve. a bloodpressure cuff is inflated around the arm to above systolic pressure for 60 seconds. numbness. Patients often report only on detailed questioning that no such symptoms affect the fifth finger. A diagram of symptoms rated as classic or probable carpal tunnel syndrome according to a standard rating system had a sensitivity of 61 percent and a specificity of 71 percent for the diagnosis of carpal tunnel syndrome in a clinic-based sample.20 but it has not been evaluated further. In Phalen's maneuver. or some combination of these symptoms on the palmar aspect of the thumb. Hence.26 . and radial half of the ring finger. Physical Examination Loss of two-point discrimination in the median-nerve distribution (inability to distinguish between one sharp point on the fingertip and two) as well as thenar atrophy occur late in the course of carpal tunnel syndrome.23 Studies of Phalen's maneuver report a wide range of values for sensitivity and specificity.22. patients report that they shake the symptomatic hand or hands when symptoms are at their worst.20.21. burning. middle finger.19. History Carpal tunnel syndrome generally produces pain.22.25 the examiner's thumb is pressed over the carpal tunnel for 30 seconds.24 In the pressure provocation test. A diagram of symptoms in the hand can help patients to localize symptoms.Diagnosis A combination of electrodiagnostic studies (nerve-conduction studies and electromyography) and knowledge of the location and type of symptoms permits the most accurate diagnosis of carpal tunnel syndrome.19 Tests of the patient's ability to perceive varying degrees of vibratory stimulation21 and direct pressure on the pulp of the finger22 in the median-nerve distribution are technically demanding and have moderate sensitivity and specificity.16 results on electrodiagnostic testing have been well documented. In the tourniquet test.13 Symptoms consistent with carpal tunnel syndrome occur in up to 15 percent of the population. although its specificity is higher (67 to 87 percent). These signs have low sensitivity and high specificity.2 and false negative14 and false positive15. the “flick sign.18 A history of nocturnal symptoms has moderate sensitivity (51 to 77 percent) and specificity (27 to 68 percent). from 40 to 80 percent.17.23 The sensitivity of Tinel's sign ranges from 25 to 60 percent. Electrodiagnostic studies are most useful for confirming the diagnosis in suspected cases and ruling out neuropathy and other nerve entrapments. tingling. Estimates of sensitivity and specificity for both of these tests vary widely. Several provocative tests may assist in the diagnosis.

it is not known whether stopping medications associated with carpal tunnel syndrome (such as corticosteroids or estrogen) leads to improvement. Treatment of other associated conditions (such as hypothyroidism or diabetes mellitus) is also appropriate. Splinting also reduces sensory latency. one group received placebo. short-term study. Medications Nonsteroidal antiinflammatory medications. The history and physical examination have poor predictive value when the likelihood of carpal tunnel syndrome is low (as it is among participants in population-based or workplace screening programs).28 suggesting that the intervention may alter the underlying course of carpal tunnel syndrome. patients were not followed after the four-week course of treatment ended. and hyperglycemia are recognized even with short-term treatment. Splints are more effective if they maintain the wrist in neutral posture rather than in extension. although risks including weight gain.29 In this small study. hypertension. and pyridoxine (vitamin B6) have each been studied in small. one received a diuretic. Splinting More than 80 percent of patients with carpal tunnel syndrome report that a wrist splint alleviates symptoms. although data are lacking on whether such treatment alleviates carpal tunnel syndrome. whereas the outcomes in the other medication groups did not differ from those in the placebo group.27 generally within days. one received nonsteroidal antiinflammatory medication. Apart from this small. and one received 20 mg of prednisolone daily for two weeks followed by 10 mg daily for another two weeks. randomized trials. with no evidence of efficacy.17 Treatment Treating Associated Conditions When carpal tunnel syndrome arises from rheumatoid arthritis or other types of inflammatory arthritis. nor did the study address the dose of corticosteroids needed to maintain a response. One four-week randomized trial involving 91 patients had four treatment groups. Local Corticosteroid Injection Patients who remain symptomatic after modification of their activities and splinting are candidates for injection of corticosteroids into the carpal tunnel. treatment of the underlying condition generally relieves carpal-tunnel symptoms.Since findings on physical examination and the history have limited diagnostic value. The prednisolone group had a substantial reduction in symptoms. diuretics. There were essentially no toxic effects of corticosteroids in this short-term trial. provided that they maintain such a neutral position. they are most useful when there is a reasonable clinical suspicion of carpal tunnel syndrome (as when a patient presents with hand symptoms). although taking such a step is also reasonable in the absence of contraindications. Similarly.27 Commercially available splints are acceptable. there have been no other placebo-controlled trials of nonsteroidal antiinflammatory medications. A 25-gauge needle may be used .

if a patient has symptoms and signs that are suggestive of axonal loss — constant numbness. the surgeon makes an incision 5 to 6 cm long.38 and many studies report that patients return to work earlier after the endoscopic surgery. extending distally from the distal wrist crease.30. symptoms for more than one year.0 to 2.30. impaired inject 1 ml of 1 percent lidocaine just to the ulnar side of the palmaris longus tendon. The endoscopic techniques carry a higher risk than open carpal-tunnel release of injury to the median nerve.32.34 The risks of infection and nerve damage resulting from corticosteroid injection are considered to be low but have not been formally studied. and weakness or thenar muscular atrophy. and releases the transverse carpal ligament under direct visualization. atrophy. In one study. or sensory loss) had recurrence of the syndrome within one year after a conservative program that included splinting and injection of corticosteroids into the carpal tunnel. This approach is used in an attempt to achieve earlier recovery while avoiding the complications associated with the . many surgeons have adopted a “mini”-open release that uses an incision of 2.34 Symptoms generally recur within one year. Many clinicians limit the number of injections into the carpal tunnel (as they would for other sites) to about three per year in order to minimize local complications (such as rupture of tendons and irritation of the nerves) and the possibility of systemic toxic effects (such as hyperglycemia or hypertension). However. Among patients with mild carpal tunnel syndrome (intermittent numbness and normal sensory and motor findings on physical examination). There are several surgical approaches to carpal-tunnel release. Injection of corticosteroids is superior to injection of placebo.32 Risk factors for recurrence include severe abnormalities on electrodiagnostic testing.32 89 percent of patients with severe carpal tunnel syndrome (constant numbness with weakness.33.37.35 In general.30. conservative treatment is more successful in patients with mild nerve impairment. the rest of the lidocaine is injected followed by the depot corticosteroid.30. If there is no paresthesia on injection of a small amount of lidocaine. Preliminary data suggest that iontophoresis with corticosteroid cream (a method that involves the use of an electrical current to deliver medication to deeper structures) may provide an alternative to corticosteroid injection. a device with either two portals36 or one portal37 is used to release the transverse carpal ligament.37-39 Relief of symptoms is similar with the open and the endoscopic procedures. The needle is aimed toward the carpal tunnel at a 30-degree angle of entry.32-34 Local injection of corticosteroids is also associated with improvement in median-nerve conduction.30.31 improving symptoms in more than 75 percent of patients.5 cm to release the transverse carpal ligament under direct visualization. The optimal number of injections per year has not been studied. Surgery In general.37-39 In recent years. For endoscopic release. proximal to the wrist crease. 60 percent had recurrence of symptoms after such conservative treatment. constant numbness. the decision about whether to proceed with carpal-tunnel–release surgery should be driven by the preference of the patient. In the traditional open procedure. loss of sensibility. and thenar muscular atrophy or weakness — surgery should be seriously considered.

an intervention involving yoga-based stretching. After surgery. Areas of Uncertainty The benefit of modifying the patient's activities remains uncertain. 70 to 90 percent of subjects report being free of nocturnal pain after surgery. Alternative Therapies Acupuncture for carpal tunnel syndrome has not been evaluated in controlled studies. If these therapies are ineffective. the guidelines recommend referral to a specialist for consideration of injection or .41.40 The efficacies of the “mini”-open. The effects of ergonomically designed equipment and frequent rest breaks on the incidence and course of carpal tunnel syndrome have not been studied rigorously. underscoring the importance of careful selection of patients for surgery. and traditional open techniques have not been compared in an adequately powered randomized trial. pain relief occurs within days.38. acupuncture. and yoga. since these activities increase carpal-tunnel pressure in patients with carpal tunnel syndrome. It is reasonable to suggest that patients minimize forceful hand and wrist activities at home and work. but hand strength does not reach preoperative levels for several months.42 Tenderness of the surgical scar may also persist for up to a year after open release. chiropractic therapy for carpal tunnel syndrome was as effective for pain as splints and medication. chiropractic. dietary supplements.45 In one study.41 Similarly.43 Also. Rigorous studies are also needed to define the effectiveness of various medications. More than 70 percent of patients report being completely satisfied or very satisfied with the results of carpal-tunnel surgery (irrespective of whether they have undergone open or endoscopic surgery). involvement of an attorney (generally to dispute a decision about a workers' compensation claim) is associated with a worse surgical outcome. or if the patient has thenar-muscle atrophy or weakness.46 but data are limited. In a randomized trial. endoscopic.43 Among workers undergoing carpal-tunnel release.41 Patients with better general functional status and mental health have more favorable outcomes after carpal-tunnel release.47 and that patients minimize any activities that exacerbate their symptoms.44 This somewhat paradoxical finding may reflect the inclusion of cases in which symptoms arise from other disorders of the arm or hand.endoscopic approach. strengthening. and relaxation in patients with carpal tunnel syndrome resulted in greater improvement in grip strength and reduction of pain than did splinting. workers with less striking abnormalities on electrodiagnostic testing have worse outcomes. as well as the optimal timing of carpal-tunnel surgery and the results of carpal-tunnel release with a “mini”open incision. Guidelines The “Clinical Guideline on Wrist Pain” from the American Academy of Orthopedic Surgeons recommends that patients with suspected carpal tunnel syndrome modify their activities for two to six weeks while they are treated with wrist splints and nonsteroidal antiinflammatory medication.41 There have been no randomized controlled trials comparing carpal-tunnel release with conservative therapy.

Fortunately. the carpal tunnel is a narrow passageway — about as big around as your thumb — located on the palm side of your wrist. If carpal tunnel syndrome seems likely. We perform electrodiagnostic studies if the diagnosis is uncertain. including the anatomy of your wrist. proper treatment usually can relieve the pain and numbness and restore normal use of their wrists and hands. certain underlying health problems and possibly patterns of hand use. for most people who develop carpal tunnel syndrome. it is advisable either to avoid the activity or to perform it without the splint. particularly if surgery is contemplated. Findings on such examination have limited diagnostic value. we recommend referral to a specialist with expertise in the diagnosis and management of carpal tunnel syndrome. diabetes and hypothyroidism.mayoclinic. Bound by bones and ligaments. hand weakness that characterize carpal tunnel A number of factors can contribute to carpal tunnel syndrome. conservative management with splinting should be initiated. however. the clinician should discuss the options of corticosteroid injection and surgical therapy with the patient. We do not recommend use of vitamin B6 (because there is no evidence of efficacy) or oral corticosteroids (given the potential for toxic effects). and will not establish the diagnosis with certainty. pain and. . Conclusions and Recommendations Patients with discomfort of the hand and wrist. such as the woman described in the vignette. We generally screen for and treat common underlying disorders — specifically. we favor the limited open incision for carpal-tunnel release. If the diagnosis appears secure.48 The practice guidelines of the American College of Occupational and Environmental Medicine49 suggest a similar approach and emphasize the importance of avoiding occupational activities that cause bothersome symptoms. we generally suggest a trial of these agents if there are no contraindications. For surgically treated patients. If the condition fails to improve. We suggest that patients reduce activities at home and work that exacerbate symptoms. Although the effects of nonsteroidal antiinflammatory medications on carpal tunnel syndrome have not been well studied. Compression of the nerve produces the numbness. Injection is especially effective if there is no loss of sensibility or thenar-muscle atrophy and weakness and if symptoms are intermittent rather than constant. should be evaluated with a detailed history of symptoms (which can be facilitated with a diagram of hand pain) and a physical examination that includes tests of sensory and motor-nerve function and provocative maneuvers. eventually. This tunnel protects a main nerve to your hand and nine tendons that bend your fingers. http://www. If splinting causes discomfort during the performance of some hand-intensive Definition By Mayo Clinic staff Carpal tunnel syndrome is a progressively painful hand and arm condition caused by a pinched nerve in your wrist.

with the exception of your little finger. thyroid disorders and kidney failure. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after the pregnancy is over. anything that crowds. A wrist fracture or dislocation that alters the space within the carpal tunnel can create extraneous pressure on the median nerve. carpal tunnel syndrome is generally more common in women. Also. as can the swelling and inflammation resulting from rheumatoid arthritis. irritating the median nerve. obesity. Illnesses that are characterized by inflammation. Nerve-damaging conditions. Inflammatory conditions. Certain conditions — such as pregnancy. • • . The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. This may be because the carpal tunnel area is relatively smaller than in men and there's less room for error. no single cause can be identified. It provides sensation to the palm side of your thumb and fingers. In many cases. exerting pressure on your median nerve. a wrist fracture can narrow the carpal tunnel and irritate the nerve. It also provides nerve signals to move the muscles around the base of your thumb (motor function). increase your risk of nerve damage. Some chronic illnesses. These include: • • Anatomic factors. irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. Although by themselves they don't cause carpal tunnel syndrome. Fluid retention — common during pregnancy. they may increase your chances of developing or aggravating median nerve damage. including damage to your median nerve. In general. It may be that a combination of risk factors contributes to the development of the condition. such as rheumatoid arthritis or an infection. menopause. for example — may increase the pressure within your carpal tunnel. For example. can affect the tendons in your wrist. among others — can affect the level of fluids in your body.Causes By Mayo Clinic staff Carpal tunnel syndrome occurs as a result of compression of the median nerve. Risk factors By Mayo Clinic staff A number of factors have been associated with carpal tunnel syndrome. such as diabetes and alcoholism. Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don't have the condition. Alterations in the balance of body fluids.

Another clue is the timing of the symptoms. tapping on the nerve or simply pressing on the nerve. can bring on the symptoms in many people. A thin-needle electrode is inserted into the muscles your doctor wants to study. Pressure on the median nerve at the wrist. Electromyogram. such as arthritis or a fracture. Physical exam. neurologist. It's possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve. gripping a steering wheel. Electromyography measures the tiny electrical discharges produced in muscles. Typical times when you might experience symptoms due to carpal tunnel syndrome include while holding a phone or a newspaper. Your doctor will want to test the feeling in your fingers and the strength of the muscles in your hand. or waking up during the night. hand surgeon or neurosurgeon if your signs or symptoms indicate other medical disorders or a need for specialized treatment. Treatments and drugs . Your doctor may recommend that you see a rheumatologist. • • • The electromyogram and nerve conduction study tests are also useful in checking for other conditions that might mimic carpal tunnel syndrome. symptoms in that finger may indicate a problem other than carpal tunnel syndrome. The pattern of your signs and symptoms may offer clues to their cause. But the scientific evidence is conflicting and these factors haven't been established as direct causes of carpal tunnel syndrome. although it may cause a different form of hand pain. Some doctors may recommend an X-ray of the affected wrist to exclude other causes of wrist pain. For example. two electrodes are taped to your skin. because these can be affected by carpal tunnel syndrome. produced by bending the wrist. since the median nerve doesn't provide sensation to your little finger. This test can help determine if muscle damage has occurred. X-ray. There is little evidence to support extensive computer use as a risk factor for carpal tunnel syndrome. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel.• Workplace factors. or worsen existing nerve damage. Tests and diagnosis By Mayo Clinic staff Your doctor may conduct one or more of the following tests to determine whether you have carpal tunnel syndrome: • • History of symptoms. such as a pinched nerve in your neck. Nerve conduction study. In a variation of electromyography. An instrument records the electrical activity in your muscle at rest and as you contract the muscle.

The surgery may be done a couple of different ways. Nonsurgical therapy If the condition is diagnosed early. Methods may include: • • Wrist splinting. Splinting and other conservative treatments are more likely to help you if you've had only mild to moderate symptoms for less than 10 months. Corticosteroids decrease inflammation and swelling. Your doctor may inject your carpal tunnel with a corticosteroid. • If carpal tunnel syndrome results from an inflammatory arthritis. Nocturnal splinting may be a good option if you are pregnant and have carpal tunnel syndrome. nonsurgical methods may help improve carpal tunnel syndrome. medications and surgery. the ligament tissues gradually grow back together while allowing more room for the nerve than existed before. that these drugs can actually improve the carpal tunnel syndrome itself. then treating the underlying condition may reduce symptoms of carpal tunnel syndrome. though. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness.By Mayo Clinic staff CLICK TO ENLARGE Carpal tunnel release Some people with mild symptoms of carpal tunnel syndrome can ease their discomfort by taking more-frequent breaks to rest their hands and applying cold packs to reduce occasional swelling. but this hasn't been proved. If these techniques don't offer relief within a few weeks. additional treatment options include wrist splinting. Surgery If your symptoms are severe or persist after trying nonsurgical therapy. During the healing process after the surgery. surgery may be the best option. There's no evidence. Corticosteroids. NSAIDs may help relieve pain from carpal tunnel syndrome in the short term. such as cortisone. which relieves pressure on the median nerve. Either technique has risks and benefits that are important to discuss with your surgeon before surgery. to relieve your pain. . Nonsteroidal anti-inflammatory drugs (NSAIDs). Oral corticosteroids aren't considered as effective as corticosteroid injections for treating carpal tunnel syndrome. The goal of carpal tunnel surgery is to relieve pressure on your median nerve by cutting the ligament pressing on the nerve. such as rheumatoid arthritis.

Try wearing a wrist splint at night. such as aspirin. .• Endoscopic surgery. as well as the upper body itself. • • If pain. ibuprofen (Advil. gradually working back to normal use of your hand while avoiding forceful hand motions or extreme positions of your wrist. Take a pain reliever. Motrin. see your doctor. • Yoga. Wrist splints are generally available over-the-counter at most drugstores or pharmacies. Lifestyle and home remedies By Mayo Clinic staff These steps may help you gain at least temporary relief from your symptoms: • • • Take quick breaks from repetitive activities involving the use of your hands. You may have to experiment to find a treatment that works for you. symptoms may not go away completely after surgery. your doctor will encourage you to use your hand after surgery. numbness or weakness recurs and persists. Carpal tunnel surgery can be done using an endoscope. surgery involves making a larger incision in the palm of your hand over the carpal tunnel and cutting through the ligament to free the nerve. The splint should be snug but not tight. a telescopelike device with a tiny camera attached to it that allows your doctor to see inside your carpal tunnel and perform the surgery through small incisions in your hand or wrist. always check with your doctor before trying any complementary or alternative treatment. If your symptoms were very severe before surgery. Yoga postures designed for strengthening. stretching and balancing each joint in the upper body. others). • In general. Still. Rotate your wrists and stretch your palms and fingers. Alternative medicine By Mayo Clinic staff Alternative forms of therapy can be integrated into your regular health plan to help you deal with the signs and symptoms of carpal tunnel syndrome. Open surgery. may help reduce the pain and improve the grip strength of people with carpal tunnel syndrome. Soreness or weakness may take from several weeks to as long as a few months to resolve after surgery. others) or naproxen (Aleve. Avoid sleeping on your hands to help ease the pain or numbness in your wrists and hands. In other cases.

org/edu/pphnews/PPHsp07p3-5. put on fingerless gloves that keep your hands and wrists warm. If you use equipment that vibrates or that requires you to exert a great amount of force.pdf http://www. use a big pen with an oversized.1056/NEJMcp013018 . Keep your hands warm. your neck and shoulder muscles are shortened. compressing nerves in your neck.pdf http://www. Give your hands and wrists a break by gently stretching and bending them periodically. hit the keys Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. Improve your posture.• Hand therapy. fingers and hands. Take frequent breaks. soft grip adapter and free-flowing ink.upmc. Incorrect posture can cause your shoulders to roll forward. Most people use more force than needed to perform many tasks involving their hands. but you can minimize stress on your hands and wrists by taking the following precautions: • • Reduce your force and relax your grip. If your work involves a cash http://www. A course of ultrasound therapy over several weeks may help improve the symptoms of carpal tunnel syndrome. If you can't control the temperature at If you use a keyboard. You're more likely to develop hand pain and stiffness if you work in a cold environment. keep it at elbow height or slightly lower. For prolonged handwriting. Ultrasound therapy. for instance. • • • http://www. Preliminary evidence suggests that certain physical and occupational hand therapy techniques may help improve symptoms of carpal tunnel syndrome. taking breaks is even more important. When your shoulders are in this position. • Prevention By Mayo Clinic staff There are no proven strategies to prevent carpal tunnel This way you won't have to grip the pen tightly or press as hard on the paper. High-intensity ultrasound can be used to raise the temperature of a targeted area of body tissue to reduce pain and promote healing.nejm. This can affect your wrists. Alternate tasks when possible.

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