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Carpal tunnel syndrome

What is it?

The carpal (kar-pull) tunnel is a small area in the wrist. Tissue, like blood vessels and the median nerve, pass through the carpal tunnel from the arm into the hand. Carpal tunnel syndrome is when the ligaments that make up the carpal tunnel become swollen and irritated. This causes painful pressure on the median nerve.

How did I get carpal tunnel syndrome? Moving your wrist in the same way over and over can cause swelling in the tunnel. This swelling puts pressure on the median nerve and causes carpal tunnel syndrome. A wrist injury, arthritis, diabetes (di-uh-b-tees), or pregnancy can also put pressure on the median nerve.

Signs and Symptoms:

You may have one or more of the following symptoms if you have carpal tunnel syndrome.

  • Dull aching pain in the hand, forearm, or upper arm.
  • Sharp pain shooting from the wrist up the arm, usually at night.
  • Stiffness of the wrist in the morning or cramping of the hands.
  • Tingling, burning, or numbness in the hand, usually in the thumb, index, and middle fingers.
  • Cannot make a fist.
  • Thumb weakness or clumsiness of the hand (dropping things).
  • Dry skin, swelling, or color changes in the hand.

Medical Care:

  • An electromyography (EMG) or nerve conduction velocity (NCV) study may be done to help caregivers learn about your wrist problem. These tests measure electrical activity of the nerves and muscles at rest and when they are in use. Sometimes blood tests are needed to learn if there is another reason for CTS. If mild, CTS may clear up by itself, simply by not doing the activity that caused the problem. Or you may need a splint or medicine to treat the problem. Sometimes, surgery is needed to free the pinched nerve.
  • The first step in treating carpal tunnel syndrome is to rest your wrist and stop the activities that are causing the problem. Resting your wrist helps the swelling go away. If your symptoms are work-related, you may need to use different equipment to decrease irritation of the carpal tunnel, such as a special keyboard. You may need to avoid some sports if activities, such as pitching, are causing your problem. When the pain, tingling, and numbness go away, begin normal, slow movements.
  • You may be given a splint to keep your wrist from bending. Always wear the splint at night. Use the splint as long as you have pain and numbness in your hand. This may take 1 to 2 months.
  • You may need physical therapy or occupational therapy to help your recovery and to prevent future problems.
  • If you have pain at night, it may help to rub or shake your hand or to hang your hand over the side of the bed.
  • Use ibuprofen or acetaminophen for pain. These may be bought over-the-counter. Do not take ibuprofen if you are allergic to aspirin.
  • You may be given shots of medicine called steroids to decrease inflammation. Caregivers may add local anesthesia to the steroids. Because these shots decrease swelling and pain, you may feel like your wrist is healed and that you can return to heavy exercise. Do not exercise until your caregiver says it is OK. You could make the carpal tunnel syndrome worse if you exercise too soon.
  • You may be given diuretics ("water pills") if you have arm swelling. Diuretics get rid of extra fluid in your arms which helps decrease carpal tunnel swelling. But diuretics make you urinate more often.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Supplements:

    Complementary Therapies:

    • Acupuncture may help CTS.
    • Chiropractic manipulation may help CTS.
    • Massage therapy may help CTS.
    • Yoga may help CTS.

    Other ways of treating your symptoms : Other ways to treat your symptoms are available to you.

    Talk to your caregiver if:

    • You would like medicine to treat carpal tunnel syndrome.
    • Your symptoms have not gone away or improved by these self-help measures.
    • You are still having pain and numbness 2 weeks after seeing your caregiver for your wrist problem.
    • You have new symptoms.
    • You have questions about what you have read in this document.

    Care Agreement:

    You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

    References:

    1. Branco K & Naeser MA: Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies--an open protocol study. J Altern Complement Med 1999; 5(1):5-26.

    2. Driskell JA, Wesley RL & Hess IE: Effectiveness of pyridoxine hydrochloride treatment on carpal tunnel syndrome patients. Nutr Rep Int 1986; 34(4):1031-1039.

    3. Garfinkel MS, Singhal A, Katz WA et al: Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA 1998; 280(18):1601-1603.

    4. Valente R & Gibson H: Chiropractic manipulation in carpal tunnel syndrome. J Manipulative Physiol Ther 1994; 17(4):246-249.


    Last Updated: 4/4/2014

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