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Carpal Tunnel Syndrome

If you’re feeling numbness, tingling, or weakness in your hand, consider asking your doctor to check you for carpal tunnel syndrome.

It’s caused by pressure on your median nerve, which runs the length of the arm, goes through a passage in the wrist called the carpal tunnel, and ends in the hand. The median controls the movement and feeling of your thumb, and also the movement of all your fingers except your pinky.

The carpal tunnel is narrowed as a result, usually from swelling.

Often, people don’t know what brought on their carpal tunnel syndrome. But it can happen due to:

  • Repetitive motions, like typing or any motions of the wrist that you do over and over. This is especially true of actions when your hands are lower than your wrist.
  • Conditions like hypothyroidism, obesity, rheumatoid arthritis, and diabetes
  • Pregnancy

If you have carpal tunnel syndrome and don’t get it treated, its symptoms can last a long time, get worse, and can even go away and return. When your doctor diagnoses it early, it’s easier to treat.

What are the Symptoms?

For many people with tingling, pain, or numbness in their fingers, carpal tunnel syndrome is the first thing to come to mind. It’s a common condition, but it’s not the only one that causes problems in your hands and wrists. It helps to know what to look for so you can get the right care. Early treatment can make a big difference in how long it takes to get better.

Carpal tunnel syndrome is caused by pressure on your median nerve. This nerve gives you feeling in your thumb and all your fingers except your pinky. When it goes through you wrist, it passes though the carpal tunnel – a narrow path that’s made of bone and ligament. If you get any swelling in your wrist, this tunnel gets squeezed and pinches your median nerve, which causes your symptoms.

What are the Early Signs?

Typically, the symptoms start out slowly, with burning, numbness, tingling or pain. You might feel it in your thumb and any of your fingers, but not your pinkie. The strange feeling may also travel up your forearm.

Often, symptoms start at night. That’s because most people sleep with their wrists bent, which causes pressure on the median nerve. You might wake up feeling like you need to shake your hands out.

As your condition gets worse, you may notice symptoms during the day, as well. This often happens when you’re doing something where your wrist is bent up or down for a long time, like driving a car, reading a newspaper, or holding your phone.

At first, symptoms tend to come and go. But over time, they occur more often and become worse.

You might also notice other symptoms:

  • Your fingers feel swollen, even though they don’t look like it
  • Pain and tingling travel up your forearm to your shoulder.
  • “Shocks” come and go in your thumb and fingers

Over time, carpal tunnel can also affect your grip and ability to pinch. Here are some things that could be happening:

  • You drop things more often (due to numbness or weakened muscles).
  • You’re having a hard time working with small objects, like the buttons on your shirt.
  • It’s harder to make a fist than it used to be.

In more severe cases, you can lose muscle at the base of your thumb. Or you may no longer be able to tell hot from cold just by touch.

When Should I Call a Doctor?

Anytime you have any of the common symptoms of carpal tunnel syndrome on a regular basis. When you get care early on, you may find that basic options, such as rest or wearing a wrist brace, work well. That’ll allow you to avoid more serious treatment like surgery. Without any treatment, you symptoms could become permanent.

What other conditions can cause similar symptoms?

Several of them. One, which doctors call de Quervain tenosynovitis, causes problems with the tendons that control your thumb. It hurts to turn your wrist, make a fist, or try to grasp an object. Your doctor can do some simple tests to tell whether you have this condition or carpal tunnel.

Other health problems that may seem like carpal tunnel syndrome include:

  • Arthritis
  • Ligament damage
  • Neuropathy, a nerve problem
  • Wrist injury, such as a fracture
  • Cervical (C6-7) root compression in the neck

It’s not as common, but for some people, carpal tunnel syndrome is caused by other health issues, like:

  • Amyloidosis, a disease where proteins collect in your organs
  • Birth control pills
  • Diabetes
  • Pregnancy
  • Rheumatoid arthritis
  • Thyroid problems

Check with your doctor to see if you have another condition that might cause carpal tunnel syndrome. If he finds you don’t have one, ask him to send you for a nerve-conduction study – what doctors call an electromyography, or EMG.

Treatment

From yoga to surgery, you have a lot options when it comes to treating carpal tunnel syndrome. Just remember that what helps your friend or neighbor may not work for you. You may need to try out different approaches to get the relief you need.

Carpal tunnel syndrome tends to come on slowly and get worse with time. But if you treat it early on, you can slow it down or stop it in its tracks. Early treatment can also make for a shorter recovery time.

Typically, you start with basic remedies, like wrist braces. For more severe cases, though, you might need surgery.

Self-care

To help ease the symptoms of carpal tunnel syndrome, you may want to put ice on your wrist or soak it in an ice bath. Try it for 10 to 15 minutes, once or twice an hour.

You can also gently shake you wrist or hang it over the side of your bed for pain that wakes you up at night.

Some experts suggest you put your hand in warm water, around 100 F, then gently flex and extend your hand and wrist. Try it 3-4 times a day.

Another way to get relief: Rest your hands and wrists as much as possible. Give them a break from things that trigger your symptoms.

To ease pain, take over-the-counter meds like aspirin, ibuprofen, or naproxen.

While these methods can help, keep in mind that they don’t cure carpal tunnel syndrome. At best, they may give you short-term relief as you try other treatments.

Wrist braces

Braces are generally best when you have mild to moderate carpal tunnel syndrome. They don’t work for everyone, but there are no side effects either, so it doesn’t hurt to try one. Make sure to give it a good 3-4 weeks for your symptoms to improve.

Your doctor will likely suggest that you wear a brace when you go to bed. That’s because most people bend their wrists when they sleep, which can make your symptoms worse. You can also try a brace during the day, especially when you do activities that trigger flare-ups.

How can a Wrist Brace Help?

Most people bend their wrists when they sleep. That puts pressure on the median nerve. A brace can help because it keeps your wrist in a straight, neutral position. A 2012 study found that using a wrist brace at night did more to relieve carpal tunnel symptoms than using no treatment at all.

You may also find it helpful to wear a brace during the day, especially during activities that trigger flare-ups. Repeated motions or extra strain on your wrist can make your symptoms worse. If your job allows for it, try wearing a brace at work.

After you take it off, be sure to keep moving your wrist as you normally would. This helps keep your muscles loose and strong. Just try to avoid too much stress or force on your wrist.

Where Can I Get One?

You can find a wrist brace, which is sometimes called a splint, in most drug stores. Or an occupational therapist can make one for you. When you put on the brace, you’ll want it to be snug, but not too tight. You want to make sure you don’t put even more pressure on your carpal tunnel.

Does A Brace Really Work?

It depends. They’re generally most helpful for folks who have mild to moderate carpal tunnel syndrome. People who use one tend to report that their symptoms last for a shorter period of time. They also feel less numbing, tingling, and burning in their wrists when they wake up.

And remember, there’s no such thing as the perfect brace. It might help to try different brands and see if they ease your pain. You may not see lasting results for up to 3-4 weeks.

Will Pain Relievers Help?

For some people, NSAIDs (nonsteroidal anti-inflammatory drugs) relieve the pain and swelling of carpal tunnel syndrome. You can buy these over the counter at your drug store. Common ones include:

  • Aspirin
  • Ibuprofen (Motrin, Advil)
  • Naproxen (Naprosyn, Aleve)

While these medicines can help, they won’t cure your condition. At best, they may provide short-term relief as you try other treatments, like a wrist brace and changes to your daily routine.

What Can Make Carpal Tunnel Syndrome Worse?

As you go about your day, try to find ways to take pressure off your wrist. Here are some things to keep in mind:

  • Avoid bending you wrist all the way up or down. A more neutral position in the middle of your range of motion is best.
  • Keep your hands warm. Cold hands can make your pain and stiffness even worse.
  • Give your hands and wrists a break as often as you can. Try not to overuse them
  • Switch up your tasks when possible to avoid repeating the same motions over and over
  • Lighten up. When it comes to tools and keyboards, more relaxed grips and motions reduce tension.

Tweak Your Activities

Carpal tunnel syndrome often gets set off when you hold your hand and wrist in the same position for a long time. It can be made even worse if you have to keep your wrist bent either up or down, so it’s best to keep it in a straight, neutral position. If your work makes that hard to do, you may want to:

  • Take a break for 10-15 minutes every hour and stretch your hands
  • Talk to your managers to see if you can change your desk, tools, or workstation setup
  • Try to alternate which hand you use for your tasks
  • Use only as much force as you need. Don’t hold your tools too tightly or pound away at your keyboard.
  • Watch your posture. Try not to roll your shoulders forward, which sets off a chain reaction that makes wrist problems even worse.

Steroids

Corticosteroids, such as cortisone, are strong drugs that can lessen swelling. You can sometimes take these medicines as pills. It’s also possible your doctor gives it to you as a shot in your wrist that goes right into the carpal tunnel. It can give you temporary relief from pain and swelling, but it’s not a long-term solution.

Physical and occupational therapy

An occupational or physical therapist can help in a couple of ways. They may give you exercises to stretch and strengthen your hand and wrist muscles. They can also show you how to change your routine motions in a way that eases stress on your hands and wrists. That can be especially helpful when it comes to tasks related to work or your favorite hobbies.

Alternative medicine

Some people with carpal tunnel syndrome have success with alternative or complimentary medicine. Always check with your doctor before trying it. Some options are:

  • Yoga. Research shows that it eases pain and boosts grip strength.
  • Ultrasound therapy. This treatment uses sound waves to raise the temperature in your hand and wrist. The heat can relieve pain and help with healing. Results from studies are mixed, but some people find it useful.
  • Acupuncture. Again, research hasn’t clearly shown that acupuncture helps with carpal tunnel syndrome, but people in some studies found it helpful.

Surgery

Most of us use our hands almost every minute of the day without ever giving it a second thought. But if you have carpal tunnel syndrome, the pain, numbness, and tingling in your fingers get your attention. Treatments like wrist braces and corticosteroids can help, but in more severe cases, you may need surgery.

When Would My Doctor Suggest Surgery?

Over time, carpal tunnel syndrome can weaken the muscles of your hands and wrists. If symptoms go on for too long, your condition will keep getting worse.

If any of these sound like your situation, your doctor might suggest surgery:

  • Other treatments – like braces, corticosteroids, and changes to your daily routine – haven’t helped.
  • You have pain, numbness, and tingling that don’t go away or get better in 6 months.
  • You find it hard to grasp, grip, or pinch objects like you once did.

What are my surgery options?

There are two main types of carpal tunnel release surgery: open and endoscopic. In both cases, your doctor cuts the ligament around the carpal tunnel to take pressure off the median nerve and relieve your symptoms. After the surgery, the ligament comes back together, but with more room for the median nerve to pass through.

  • Open surgery involves a larger cut, or incision – up to 2 inches from your wrist to your palm.
  • In endoscopic surgery, your surgeon makes one opening in your wrist. He may also make one in your arm. These cuts are smaller, about a half-inch each. He then places a tiny camera in one of the openings to guide him as he cuts the ligament.

Because the openings are smaller with endoscopic surgery, you may heal faster and have less pain. Ask your doctor which operation is best for you.

Results and Risks

Most people who have carpal tunnel surgery find that their symptoms get cured and don’t come back. If you have a very severe case, surgery can still help, but you may still feel numbness, tingling, or pain from time to time.

Risks come with any operation. For both types of carpal tunnel release surgery, they include:

  • Bleeding
  • Damage to your median nerve or nearby nerves and blood vessels
  • Infection of your wound
  • A scar that hurts to touch

What’s the Surgery Like?

First, you’ll get local anesthesia – drugs to numb your hand and wrist. You may also get medicine to help keep you calm. (General anesthesia, which means you will not be awake during surgery, is not common for carpal tunnel syndrome).

When the operation is finished, your doctor stitches the openings shut and puts a large bandage on your wrist. This protects your wound and keeps you from using your wrist.

Your doctor and nurses will keep an eye on you for a little while before letting you go home. You’ll likely leave the hospital the same day. Overnight stays are rare.

How long does it take to heal?

You may get relief from symptoms the same day as your surgery, but complete healing takes longer. Expect to have pain, swelling, and stiffness after the operation. Your doctor will let you know what medicines might help. You may have some soreness for anywhere from a few weeks to a few months after surgery.

Your bandage will stay on for 1-2 weeks. Your doctor may give you exercises to do during this time to move your fingers and keep them from getting too stiff. You can use your hand lightly in the first 2 weeks, but it helps to avoid too much strain.

Slowly you get back to more normal activities, like:

  • Driving (a couple of days after surgery)
  • Writing (after a week, but expect 4-6 weeks before it feels easier.)
  • Pulling, gripping, and pinching (6-8 weeks out, but only lightly. Expect 10-12 weeks before your full strength returns, or up to a year in more severe cases.)

Your doctor will talk to you about when you can go back to work and whether you’ll be limited in what you can do.

Will I Need Occupational Therapy?

If you do, your doctor will suggest it once your bandage comes off. You’ll learn exercises to improve your hand and wrist movement, which can also speed up healing.

Some people find that their wrists aren’t as strong after surgery as they were before. If this happens to you, occupational therapy can help increase your strength.

What Can a Physical Therapist Provide?

A physical therapist is a medical professional who can work with you to reduce your pain and help you regain strength and mobility. If she specializes in hand physical therapy, she can recommend something called “gliding” exercises. These focus on nerves and tendons. The goal is to help reduce pain and increase mobility.

Your therapist might also suggest a brace. You’ll wear this at night to keep your wrist straight. And you might wear it during the day, when you’re doing activities that may worsen your symptoms.

Some other things your physical therapist might suggest are:

  • Changes you can make to help reduce your symptoms at work, at home, and in your leisure time
  • Ultrasound, the use of high frequency vibrations to decrease symptoms
  • A special hand traction device to help make your carpal tunnel area larger through stretching

Will Physical Therapy Work for Me?

That depends on how well you respond to treatment and whether physical therapy will help you meet your goals of pain relief and better hand function.

But research is promising.

In a recent study, doctors in Spain divided 120 women with carpal tunnel syndrome into two groups. One group got surgery. The other group was treated with physical therapy. The therapists focused on the soft tissue in their arms and hands. The goal was to stop irritation of the median nerve, the culprit behind the condition.

Researchers follows up with both groups of women several times over a year. What they found is that both physical therapy and surgery can help, but physical therapy led to better outcomes in the short term. The women who received therapy had less pain and better function much earlier compared with those who had surgery.

Could physical therapy help your carpal tunnel syndrome? Talk to your doctor. If you do choose to have therapy, your physical therapist will follow up with your doctor to talk about your progress and make other recommendations.

What about Physical Therapy after Surgery?

Doctors recommend it to help your wrist get stronger.

But the benefits don’t stop there: Your therapist can also help you manage your surgical scar to prevent any complications. She can also recommend specific exercises to help you regain mobility and flexibility after surgery.

Prevention

There’s no one, surefire way to prevent carpal tunnel syndrome. But if you reduce stress and strain on your hands and wrists as much as you can, you may keep it from getting worse.

Try a Softer Touch

Often in our daily routines, we get so used to doing things a certain way that we don’t even think about it. Many times, you may use more force than you need to get the job done. For instance, you might grip your tools too tightly when a firm hold is plenty. Or you may pound your computer keyboard when gentle keystrokes will do.

As you go through your day, keep an eye on how tense your hands are and how much pressure you put on them. If you can back off even a little, your hands and wrists will thank you.

Give Yourself a Break

Step away from your work to bend or stretch your hands. A 10- to 15-minute break every hour is ideal. This is especially important if you use tools that vibrate or make you apply a lot of force.

Stretch Often

When you take those breaks (or any time throughout the day), try this simple stretch:

  • Make a fist
  • Slide your fingers up until they point straight out
  • Repeat 5-10 times

Or this one:

  • Make a fist
  • Release your fingers and fan them out. Stretch them as far as you can.
  • Repeat 5-10 times

Stay Neutral

If you can, avoid bending your wrist all the way up or down. When you keep your wrist in a straight, neutral position, it takes the pressure off your median nerve.

Wearing a wrist brace when you sleep can help you do this. It might also help to wear it during activities that trigger your symptoms.

Switch It Up

Try to avoid doing the same hand and wrist motions over and over again. For example, if you have a task that you always do with your right hand, do it with your left instead. Or, mix up your tasks as much as you can to give your muscles a break.

Watch Your Posture

While it’s natural to focus on your wrist and hands, how you hold the rest of your body can also make a difference. Poor posture may cause you to roll your shoulders forward. This sets off a chain reaction that shortens your neck and should muscles, crunches the nerves in your neck, and makes wrist problems worse.

Stay Warm

It sounds simple, but it makes a difference. When you’re cold, pain and stiffness get worse. Even gloves with no fingers can be helpful because they keep your hands and wrists warm and loose.

Talk to Your Supervisor

If your work triggers your symptoms, ask your manager about changing up your workspace. You may be able to alter anything from your workstation setup to tool handles to how tasks get done to see if it helps your symptoms. You might also be able to trade off with co-workers so you can avoid the same task over and over.

If you work at a computer, try these things:

  • Adjust your keyboard position so you don’t have to bend your wrists when you type.
  • Keep your elbows close to your side as you type