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Carpal tunnel syndrome

Published by Bupa's health information team, September 2008.

This factsheet is for people who have carpal tunnel syndrome, or who would like information about it.

Carpal tunnel syndrome is pain or weakness in your forearm and hand caused by pressure on a nerve in your wrist.

About carpal tunnel syndrome
Symptoms of carpal tunnel syndrome
Causes of carpal tunnel syndrome
Diagnosis of carpal tunnel syndrome
Treatment of carpal tunnel syndrome
Further information
Questions and answers
Video
Related topics
Sources

About carpal tunnel syndrome

The carpal tunnel is a channel in the palm side of your wrist (see illustration). The bones of your wrist are arranged in a semi-circle, and a tough ligament called the transverse carpal ligament (flexor retinaculum) forms a roof over them, creating a passageway (the carpal tunnel). Running through your carpal tunnel are the tendons that you use to bend your fingers and wrist, and your median nerve. This is one of three nerves that connect to your hand. Your median nerve also controls some of the muscles that move your thumb.

You can get carpal tunnel syndrome if there is too much pressure on your median nerve.

Carpal tunnel syndrome doesn't develop in a predictable way. Sometimes it simply gets better without any treatment.

Carpal tunnel syndrome is a fairly common condition. About three in 100 men and 11 in 100 women develop carpal tunnel syndrome at some point in their life.

Symptoms of carpal tunnel syndrome

If you have carpal tunnel syndrome, you may have numbness, tingling and burning in your hand and fingers. You can sometimes get pain in your forearm and sometimes as far as your shoulder and neck. Usually only your thumb, index and middle fingers, and the side of your ring finger nearest your thumb are affected (see illustration). Carpal tunnel syndrome tends to be worse at night or first thing in the morning. Shaking your hand can relieve the sensation. In the morning it can feel better after you have used your hand for a while, but symptoms often come back during the day.

Your symptoms may be mild or only occur from time to time, but if the carpal tunnel syndrome gets worse they may become continuous. Your hand muscles may become weakened, making it difficult to grip objects or perform other manual tasks. In severe, long-lasting cases your thumb muscles may start to waste away or your median nerve may be permanently damaged.

Illustration showing the carpal tunnel and median nerve
The carpal tunnel and median nerve

Causes of carpal tunnel syndrome

Because there isn't much room in the carpal tunnel, any swelling around it can press on your median nerve, causing the symptoms of carpal tunnel syndrome. Women are more likely to get it than men, and it tends to develop over the age of 45. In addition, if you are overweight or have a job where you use your hands a lot, you are more likely to develop the condition.

You may also get carpal tunnel syndrome if you:

start doing a manual job you aren't used to, such as house painting
have rheumatoid arthritis in your wrist joint
are pregnant
have thyroid problems
have acromegaly, a condition caused by too much growth hormone (a chemical produced naturally by your body)
have diabetes
have cysts in your carpal tunnel
take certain medicines, such as the oral contraceptive

For many people, it isn't known why carpal tunnel syndrome develops. Other nerve and tendon disorders may produce similar symptoms.

Diagnosis of carpal tunnel syndrome

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may tap on your wrist and ask you to bend your palm to see if he or she can reproduce the symptoms of carpal tunnel syndrome. If this happens, it's likely that you have carpal tunnel syndrome.

If your GP isn't sure whether you have carpal tunnel syndrome, he or she may refer you to a neurologist (a doctor specialising in conditions that affect the nervous system) for a nerve conduction test. To do this, wires are attached to your fingers and wrist, and small electric shocks applied. This test can assess your nerve conduction and find out if there is any damage to the median nerve.

Treatment of carpal tunnel syndrome

Carpal tunnel syndrome treatment aims to relieve your symptoms by reducing the pressure on the median nerve. You should start your treatment as early as possible, under the guidance of your GP. Sometimes, carpal tunnel syndrome improves without any treatment.

Self-help

If your condition is linked to the way you use your hands, it's important to try to change how you do things. Changing the way you make repetitive movements, reducing how often you do them, and increasing the amount of rest between periods of activity should help.

Stretching exercises can help to relieve your symptoms and keep the area mobile. Some studies indicate that special hand exercises - called nerve tendon and gliding exercises - can help.

Mild symptoms can be relieved by resting your hands and wrists regularly and by applying a cold compress, such as ice or a bag of frozen peas, wrapped in a towel. You shouldn't apply ice directly to your skin as it can damage your skin.

Medicines

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen don't seem to have much effect on carpal tunnel syndrome symptoms unless it's caused by an inflammatory condition. Diuretics (water tablets) have also been prescribed for carpal tunnel syndrome but recent studies don't show any benefit.

There are other medicines available for carpal tunnel syndrome that your GP may prescribe for you.

Corticosteroid tablets (for example prednisolone) for two to four weeks can provide relief of your symptoms in the short term but they have side-effects if you take them for a long time.
Your GP may suggest steroid injections (for example hydrocortisone) into the carpal tunnel. Your pain may get a little worse for a couple of days after the injection, but symptoms should improve after that.

Complementary therapies

You may have heard that acupuncture helps to relieve symptoms of carpal tunnel syndrome, but there is no scientific evidence to back this up. Also there is no evidence to suggest that vitamin B6 (pyroxidine) tablets help.

There is some evidence that performing yoga reduces pain in people with carpal tunnel syndrome.

Non-surgical treatments

Wrist splints are often recommended for you to use either at night, or both day and night although you may find they get in the way when you're doing daily activities. These help to keep your wrist straight and reduce pressure on the compressed nerve.

Research indicates that ultrasound treatment can help reduce the symptoms of carpal tunnel syndrome.

Surgery

If your symptoms are severe, your GP may suggest you have carpal tunnel release surgery. This operation involves cutting your carpal ligament to make more space for the nerves and tendons in the carpal tunnel. It’s usually done as day-case surgery under a local anaesthetic. For more information please see the related Bupa factsheet, Carpal tunnel release surgery.

Further information

Arthritis Research Campaign
0870 850 5000
www.arc.org.uk