Pressure on the median nerve, which is inside a narrow passage in the wrist called the carpal tunnel, causes the nerve to malfunction. This nerve provides feeling to the thumb, index and middle fingers, and half of the ring finger. It also controls several muscles in the hand, the most important of which allows the thumb to touch the little finger. Pinching occurs when the tissues in the carpal tunnel swell up.
Carpal tunnel syndrome is a repetitive strain injury. Although there are many causes for carpal tunnel syndrome, by far the most common is doing repetitive motions as part of your job. Fragmentation of work to the point that one person does one task over and over has been blamed for the increase in cases of carpal tunnel syndrome in recent years. There are approximately 1 million new cases every year.
It is possible to develop carpal tunnel syndrome with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing carpal tunnel syndrome. If you have a number of risk factors, ask your health care provider what you can do to reduce your risk. Risk factors of carpal tunnel syndrome include:
The vast majority of carpal tunnel syndrome cases are work-related. People whose occupations involve repetitive work with the hands, such as keyboard operators, factory workers, typists, barbers, musicians, and vehicle drivers, are at increased risk. In addition, people who use vibrating tools, such as jack hammers, chain saws, chippers, grinders, drills, and sanders, for long periods every day may be at increased risk.
Wrist injuries, such as burns, broken bones, compression or crush injuries, may increase your risk of developing carpal tunnel syndrome.
Having the following medical conditions may increase your risk of developing carpal tunnel syndrome:
Carpal tunnel syndrome is most often diagnosed between the ages of 40 and 60.
Women are diagnosed with carpal tunnel syndrome three times more often than men.
Inheriting a narrowed carpal tunnel increases your chances of developing carpal tunnel syndrome.
Carpal tunnel syndrome causes symptoms in one or both hands that may also extend up the arm. Symptoms are caused by pinching of the median nerve in the carpal tunnel. This nerve supplies feeling to the thumb, index, middle, and half of the ring finger, as well as to the muscles that move the thumb toward the little finger and move the index finger around in a circle.
Simple tests for carpal tunnel syndrome include:
You have a unique medical history. Therefore, it is essential to talk with your doctor or health care provider about your personal risk factors and/or experience with carpal tunnel syndrome. By talking openly and regularly with your health care provider, you can take an active role in your care. Here are some tips that will make it easier for you to talk to your health care provider:
About treatment options:
About lifestyle changes:
About your outlook:
The treatment and management of carpal tunnel syndrome requires that pressure in the carpal tunnel be reduced. There are several ways to do this. As with all health problems, the safest and simplest treatments are tried first. If your carpal tunnel syndrome is due to another treatable condition, such as diabetes or a hormone disorder, that condition may be treated first to see if the carpal tunnel syndrome resolves.
If your carpal tunnel syndrome is caused by repetitive strain, then lifestyle has everything to do with your symptoms, and you’ll need to make some changes. Contact your health care provider when your symptoms begin to interfere with your activities.
A simple change in how your wrists are positioned during sleep may solve early symptoms. Sleep with your wrists cocked upward instead of bent downward to minimize pressure in the carpal tunnel.
The more comfortable your workplace, and the closer your work activity conforms to the way your body works, the less chance of discomfort or reduced performance.
Check the tools you use at work
According to a report published by the American Academy of Orthopaedic Surgeons, a simple warm-up routine may greatly reduce the incidence of carpal tunnel syndrome. This routine, combined with medication and rest, may prove to be better at treating symptoms than simple rest and medication.
The warm-up routine is as follows:
Both caffeine and tobacco reduce blood flow to your hands. Nerve tissue is the most sensitive to reduced blood flow. Avoid caffeine and tobacco so that you don’t decrease blood flow to these areas any further.
The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your health care provider if you need to take any special precautions. Use each of these medications as recommended by your health care provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your health care provider.
Medications for carpal tunnel syndrome are prescribed to reduce swelling in the carpal tunnel. Two different kinds of medicine may be effective, but both are aimed at reducing inflammation, a primary cause of swelling in this area.
There are currently 20 prescription NSAIDs on the market, each having a slightly different chemistry and side effect profile. NSAIDs can be as effective as cortisone and are safer over the long run, although they do have side effects. The newer and more expensive selective NSAIDs (celecoxib and rofecoxib) are expected to produce fewer stomach and intestinal problems.
Common names include:
Take special care with NSAIDs if you have had an ulcer or gastritis, as they can irritate these conditions. Tell your doctor if you have a stomach condition before you start taking any of these medications.
An injection of cortisone directly into the carpal tunnel may be used to treat carpal tunnel syndrome if rest, medications, and lifestyle changes are not working. This is a simple office procedure that is quite safe if done infrequently. Cortisone reduces inflammation, thereby reducing the swelling and pressure inside the carpal tunnel.
Injections very rarely cause excessive bleeding and even more rarely cause infection. If there is excessive pain or swelling, contact your health care provider.
Lower doses of non-steroidal anti-inflammatory drugs (NSAIDs) are sold over the counter and include:
Take special care with NSAIDs if you have had an ulcer or gastritis. They can irritate these conditions. Tell your doctor if you have a stomach condition before you start taking any of these medications.
Whenever you are taking a presription medication, take the following precautions:
You may reduce your chances of getting carpal tunnel syndrome by taking these steps:
If you work in an office, adjust your desk, chair and keyboard so you are in the best possible position:
Take breaks at least once an hour to:
Get regular aerobic exercise such as walking or swimming.
Cut down on caffeine and smoking, which may reduce blood flow to your hands.
Keep in mind that the rehabilitation exercises should be continued to ensure protective strength, range of motion, and stability.
The key to improving sports performance after recovering from carpal tunnel syndrome is a proper a rehabilitation program, and adhering to some of those same principles after the injury is gone.
The single most important aspect of improving performance is performing proper stretching exercises before and after you step onto the field, court, ice or golf course. Benefits derived from stretching include:
As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important.
The most common rehabilitation for carpal tunnel syndrome often includes the following:
The major objectives of rehabilitation from carpal tunnel syndrome are to improve the elasticity of the carpal tunnel and to gradually increase pain-free range of motion of the hand, wrist, thumb, and fingers. The exercises below may help achieve this. These exercises should be performed once or twice daily.
During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:
Keep in mind that if your carpal tunnel syndrome requires surgery, the soft tissue needs time to heal before exercise can begin.
A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.
Finally, patients develop speed and agility through sport-specific exercise routines.
The ultimate goal of carpal tunnel surgery is to provide dynamic stability while maintaining full range of motion, so that athletes can return to competitive or recreational sports. Progress is assessed by the patient's perception of how stable the hand/wrist feels and by comparing the strength and stability of the injured and uninjured hands.
Some may be ready for participation in a week, others not for two or more weeks. Of course, time for return-to-activity is much longer if surgery is necessary. Keep in mind that carpal tunnel syndrome may recur if the causative activity is continued. Just be sure to continue the exercises and prevention techniques to reduce risk of a recurrence.
Remember: The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your carpal tunnel syndrome recovers, not by how many days or weeks it has been since your injury occurred