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Carpal tunnel syndrome

Published by Bupa's Health Information Team, July 2010.

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

Carpal tunnel syndrome is a condition that causes pain or weakness in the forearm and hand. It's caused by pressure on a nerve in the 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
Questions and answers
Related topics
Video
Further information
Sources

About carpal tunnel syndrome

Your carpal tunnel is a channel in the palm side of your wrist. The bones of your wrist are arranged in a semi-circle. A tough ligament, known as the transverse carpal ligament, forms a roof over these bones, creating a passageway known as your carpal tunnel. The tendons that you use to bend your fingers and wrist pass through your carpal tunnel. Your carpal tunnel also surrounds your median nerve, which is one of three nerves that connect your wrist to your hand. Your median nerve controls some of the muscles that move your thumb.

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

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

About three in 100 men and five in 100 women develop carpal tunnel syndrome at some point in their life.

Symptoms of carpal tunnel syndrome

If you have carpal tunnel syndrome, your hand and fingers may:

feel numb
tingle
burn

You're most likely to get these symptoms in your thumb, index and middle fingers and the side of your ring finger nearest your thumb. You may also get aching or pain in your forearm, shoulder and neck. Your symptoms may be mild or may last for only short periods of time.

Carpal tunnel syndrome tends to be worse at night or first thing in the morning. Your symptoms may get better after you have used your hand for a while, but may then come back later in the day.

If you have these symptoms, contact your GP for advice.

If your symptoms occur all of the time, your hand muscles can become weak. This may make it more difficult for you to grip objects or perform other manual tasks. If you have severe, long-lasting carpal tunnel syndrome, your thumb muscles may start to waste away or your median nerve may become permanently damaged. Occasionally, you may experience changes to the colour and feel of the skin of your hand.

Causes of carpal tunnel syndrome

Because there isn't much room in your carpal tunnel, any swelling around it can press on your median nerve, causing the symptoms of carpal tunnel syndrome.

You're more likely to develop the condition if you're overweight or have a job where you use your hands a lot. You may also get carpal tunnel syndrome if you:

have a job that involves repeated forceful movements of your wrist, such as using a screwdriver
have rheumatoid arthritis in your wrist joint
are pregnant
have thyroid problems
have acromegaly - a condition caused by too much growth hormone
have diabetes
have cysts in your carpal tunnel

Carpal tunnel syndrome is more likely to affect women than men, and it tends to develop in people over 45.

One in four people who have carpal tunnel syndrome have a relative who also has the condition.

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 the palm of your hand 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 who specialises in conditions that affect the nervous system) for a nerve conduction test. This test can show if there is any damage to your median nerve. During the test, your doctor attaches wires to your fingers and wrist and applies small electric shocks to measure how quickly messages pass through your median nerve.

Treatment of carpal tunnel syndrome

Treatment helps to relieve your symptoms by reducing the pressure on your median nerve and may stop your condition getting any worse.

Sometimes carpal tunnel syndrome improves without any treatment after six months, especially if you're pregnant or under 30.

Self-help

If repetitive hand movements are causing your condition, it's important to try to limit any activities that make your symptoms worse. It may help if you change the way you make repetitive movements, reduce how often you do them and increase the amount of rest you take between periods of activity.

Resting your hands and wrists regularly may relieve mild symptoms of carpal tunnel syndrome. Shaking your hands when they are numb or tingling may also help.

When your symptoms flare up, try applying a cold compress, such as an ice pack or ice wrapped in a towel. You shouldn't apply ice directly to your skin as it can damage your skin.

Medicines

Your GP may prescribe corticosteroid tablets (eg prednisolone) in the short term to treat carpal tunnel syndrome. However, these medicines can cause side-effects if you take them for a long time. Always ask your doctor for advice and read the patient information leaflet that comes with your medicines.

Your GP may give you steroid injections into your carpal tunnel. Your pain may get a little worse for a couple of days after the injection, but your symptoms should improve after that.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, don't have much effect on carpal tunnel syndrome unless it's caused by an underlying inflammatory condition. Diuretic medicines (water tablets) won't improve your symptoms unless you also have fluid retention in your wrist.

Non-surgical treatments

Wrist splints help to keep your wrist straight and reduce pressure on the compressed nerve. Your doctor may recommend that you wear wrist splints either at night, or both day and night, although you may find that they get in the way when you're doing your daily activities.

Some research indicates that ultrasound treatment (treatment with sound waves) may help reduce the symptoms of carpal tunnel syndrome.

Surgery

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

Physical therapies

There is no scientific evidence that any general hand or wrist exercises can relieve the symptoms of carpal tunnel syndrome. More research is needed to see whether special hand exercises - called nerve tendon and gliding exercises - can help.

Complementary therapies

There is no scientific evidence to suggest that acupuncture helps to relieve symptoms of carpal tunnel syndrome. There is also no evidence to suggest that vitamin B6 (pyroxidine) tablets help. However, there is some evidence that performing yoga may help to reduce pain in people with carpal tunnel syndrome.

Always seek advice from your doctor or pharmacist before trying any complementary therapies. If you choose to try a complementary therapy, check that your therapist is affiliated to a recognised organisation.