Carpal Tunnel Syndrome and Wrist Pain: Causes, Care and When to Be Seen

What it involves

MedlinePlus defines carpal tunnel syndrome as a condition in which there is too much pressure on the median nerve at the wrist, the nerve that allows feeling and movement in parts of the hand. It can lead to pain, numbness, tingling, weakness, or muscle damage in the hand and fingers. The carpal tunnel is the narrow passage in the wrist where that nerve enters the hand.

Who this is for

• Adults with numbness or tingling in the thumb and the next fingers, especially at night
• Patients whose grip feels weak or who keep dropping things
• Patients with wrist pain that travels up toward the elbow
• Patients who use vibrating tools, type, or do repetitive hand work and want to know what to change

What to expect

• Questions about which fingers go numb, when it happens, and what your hands do all day
• An exam of the wrist and hand, including grip strength and feeling in each finger
• A plain explanation of whether the pattern fits carpal tunnel syndrome or another cause
• A plan that may include a wrist splint, medicine, or a referral for nerve testing or a specialist

Which fingers it affects

MedlinePlus says the median nerve typically provides feeling to the thumb side of the hand: the palm, the thumb, the index finger, the middle finger, and the thumb side of the ring finger. The carpal tunnel is normally narrow, with a thick ligament forming its top, so any swelling can pinch the nerve. Some people are born with a small carpal tunnel.

Symptoms to look for

MedlinePlus lists these symptoms of carpal tunnel syndrome:

• Numbness or tingling in the thumb and the next two or three fingers, or in the palm
• Pain in the wrist or hand, sometimes extending to the elbow
• A weak grip or difficulty carrying bags, which it calls a common complaint
• Clumsiness when gripping objects and trouble with fine finger movements
• In advanced or long-term cases, wasting of the muscle under the thumb

What can contribute

MedlinePlus says carpal tunnel syndrome can be caused by making the same hand and wrist motion over and over, and that vibrating hand tools such as drills or hammers may lead to it. It adds that studies have not proved that typing or using a mouse causes it, though those activities may cause tendinitis or bursitis that narrows the tunnel. It occurs most often in people ages 30 to 60 and is more common in women. Other factors it lists include:

• Alcohol use, obesity, and rheumatoid arthritis
• Wrist fractures and arthritis of the wrist, or a cyst or tumor in the wrist
• Extra fluid retained during pregnancy or menopause
• Infections, and diseases with abnormal protein deposits in the body

How it is checked

MedlinePlus says a provider may find numbness in the median nerve area and a weak grip, and two simple exam tests are named for it: tapping over the nerve at the wrist, called the Tinel sign, and holding the wrist bent down for 60 seconds, called the Phalen test. Tests that may be ordered include wrist x-rays, electromyography, and nerve conduction velocity, which would be arranged through a referral. The numbness and tingling guide covers the other causes a provider rules out.

Splints, habits, and workplace changes

MedlinePlus says your provider may suggest wearing a wrist splint at night for several weeks, then during the day as well if that does not help, and avoiding sleeping on your wrists. It also lists warm and cold compresses. For work, it suggests special keyboards or mice, cushioned mouse pads, and having someone review the position you work in, for example keeping the keyboard low enough that your wrists are not bent upward. An occupational therapist may help with that assessment. Always stop typing if you feel tingling or pain.

Medicines and surgery

MedlinePlus lists anti-inflammatory medicines such as ibuprofen or naproxen, and corticosteroid injections into the carpal tunnel area, and says these treatments usually give only temporary relief. Carpal tunnel release is a surgical procedure that cuts the ligament pressing on the nerve. MedlinePlus says symptoms often improve without surgery, but more than one half of cases eventually need it, and full healing can take months. Surgery would be arranged through a referral.

Signs you should be seen

MedlinePlus says to contact your provider for an appointment if you have symptoms of carpal tunnel syndrome, and especially if:

• Symptoms do not respond to rest and anti-inflammatory medicines
• There seems to be a loss of muscle bulk around the fingers
• Your fingers lose more and more feeling
• You are dropping things and becoming more clumsy with your hand

Sources

• MedlinePlus — Carpal tunnel syndrome