Carpal tunnel syndrome

Carpal tunnel syndrome is a painful condition that can affect your ability to use and feel your wrist and hand. At Atrium Health Floyd and Harbin Clinic, our orthopedic specialists provide nonsurgical and surgical treatments to ease wrist pain and improve movement.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a common hand and wrist problem that results from a pinched nerve. Pressure on the median nerve in the wrist affects how your hand and wrist feel and move.

Causes of carpal tunnel syndrome

Excess pressure on the median nerve causes carpal tunnel syndrome. The median nerve provides feeling and movement to your forearm (lower part of the arm), palm, thumb, and index and middle fingers. This nerve runs through the carpal tunnel, a narrow opening inside the wrist that’s surrounded by bones and ligaments.

Swelling inside the carpal tunnel can lead to a pinched nerve and carpal tunnel syndrome. Many things can cause this swelling and pinching, including:

• Arthritis
• Cysts and tumors
• Infections
• Fractured wrist
• Repetitive wrist movements
• Sprains and strains

Carpal tunnel syndrome symptoms

Signs of carpal tunnel syndrome typically come on gradually. You may have mild pain or loss of sensation that gets worse over time. Carpal tunnel syndrome symptoms include:

• Difficulty using your hands to grip, carry, hold or move items
• Hand, wrist or forearm pain that may extend to the elbow
• Numbness or tingling in the palm, forearm, thumb and/or fingers
• Weakness in one or both hands

Carpal tunnel syndrome diagnosis

Your health care provider will conduct a physical exam and ask about your symptoms and medical history. Tests that may help your provider diagnose carpal tunnel syndrome and rule out other conditions include:

• Imaging tests, such as MRI or ultrasound, to view your nerves and ligaments, or X-rays to view your bones and cartilage
• Phalen’s test to check for numbness, tingling or weakness when you bend your hands and wrist into different positions
• Tinel’s sign test to see if you feel a tingling sensation when your provider taps the skin above the median nerve
• Electromyography (EMG) and nerve conduction study (NCS) to assess nerve and muscle function

Carpal tunnel syndrome risk factors

Your chances of developing carpal tunnel syndrome increase as you get older. Other factors that can raise your risk include:

• Alcohol addiction
• Diabetes
• Family history of carpal tunnel syndrome
• Female sex assigned at birth
• Fibromyalgia
• Hobbies, jobs or sports that require repetitive wrist or hand movements
• Hypothyroidism (underactive thyroid gland)
• Obesity
• Pregnancy

Complications of carpal tunnel syndrome

Continuous pressure on the median nerve can lead to permanent nerve damage if it is not treated. If this occurs, you might not be able to feel or move your hand and fingers.

Carpal tunnel syndrome prevention

You can’t always prevent carpal tunnel syndrome. But these actions may help:

• Avoid repetitive wrist and hand movements if possible
• Maintain a healthy weight
• Stretch your wrists and hands before physical activity
• Take frequent breaks and use proper form when working with your hands

Carpal tunnel syndrome treatments

Your doctor will start with nonsurgical treatments. They will likely refer you to a physical therapist, who can help improve your wrist's range of motion and flexibility.

Other nonsurgical treatments for carpal tunnel syndrome include:

• Applying warm and cold compresses to the wrist
• Modifying your work activities, such as using cushioned wrist pads while working on a computer
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections to reduce swelling
• Wearing wrist splints to take pressure off the median nerve, especially while you sleep

If symptoms persist or worsen, you may need surgery to open space inside the carpal tunnel and relieve pressure on the median nerve.