Carpal tunnel syndrome

Diagnosis

Your provider may ask you questions and conduct one or more of the following tests to determine whether you have carpal tunnel syndrome:

• History of symptoms. Your provider will review the pattern of the symptoms. For example, because the median nerve doesn't provide sensation to the little finger, symptoms in that finger may indicate a problem other than carpal tunnel syndrome.

  Carpal tunnel syndrome symptoms usually occur while holding a phone or a newspaper or gripping a steering wheel. They also tend to occur at night and may wake you during the night, or you may notice the numbness when you wake up in the morning.

• Physical examination. Your provider will conduct a physical examination. He or she will test the feeling in the fingers and the strength of the muscles in the hand.

  Bending the wrist, tapping on the nerve or simply pressing on the nerve can trigger symptoms in many people.

• X-ray. Some providers recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture. However, X-rays are not helpful in making a diagnosis of carpal tunnel syndrome.
• Ultrasound. Your provider may recommend an ultrasound of your wrist to get a good picture of the bones and nerve. This can help determine whether the nerve is being compressed.
• Electromyography. This test measures the tiny electrical discharges produced in muscles. During this test, your provider inserts a thin-needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. This test can identify damage to the muscles controlled by the median nerve, and also may rule out other conditions.
• Nerve conduction study. In a variation of electromyography, two electrodes are taped to the skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose the condition and rule out other conditions.

Treatment

Treat carpal tunnel syndrome as early as possible after symptoms start. In the early stages, simple things that you can do for yourself may make the problem go away. For example:

• Take more-frequent breaks to rest the hands.
• Avoid activities that make symptoms worse.
• Apply cold packs to reduce swelling.

Other treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help if you've had only mild to moderate symptoms that come and go for less than 10 months. If you have numbness in your hands, you need to see a health care provider.

Nonsurgical therapy

If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome, including:

• Wrist splinting. A splint that holds the wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Even though you only wear the splint at night, it can also help prevent daytime symptoms. Nighttime splinting may be a good option if you're pregnant because it does not involve the use of any medications to be effective.

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.

  There isn't evidence, however, that these drugs improve carpal tunnel syndrome.

• Corticosteroids. Your provider may inject the carpal tunnel with a corticosteroid such as cortisone to relieve pain. Sometimes the provider uses an ultrasound to guide these injections.

  Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren't considered as effective as corticosteroid injections for treating carpal tunnel syndrome.

If carpal tunnel syndrome is caused by rheumatoid arthritis or another inflammatory arthritis, then treating the arthritis may reduce symptoms of carpal tunnel syndrome. However, this is unproved.

Surgery

Surgery may be appropriate if symptoms are severe or don't respond to other treatments.

The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.

The surgery may be performed with two different techniques:

• Endoscopic surgery. Your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside the carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in the hand or wrist. Some surgeons may use ultrasound instead of a telescope to guide the tool that cuts the ligament.

  Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.

• Open surgery. Your surgeon makes an incision in the palm of the hand over the carpal tunnel and cuts through the ligament to free the nerve.

Discuss the risks and benefits of each technique with your surgeon before surgery. Surgery risks may include:

• Incomplete release of the ligament
• Wound infections
• Scar formation
• Injuries to the nerves or blood vessels

During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve. This internal healing process typically takes several months, but the skin heals in a few weeks.

Your provider generally will encourage you to use the hand after the ligament has healed, gradually working back to normal use of the hand while initially avoiding forceful hand motions or extreme wrist positions.

Soreness or weakness may take from several weeks to a few months to resolve after surgery. If your symptoms were very severe, symptoms may not go away completely after surgery.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

These steps may provide temporary symptom relief:

• Take short, frequent breaks from repetitive activities involving the use of the hands.
• Lose weight if you are overweight or obese.
• Rotate the wrists and stretch the palms and fingers.
• Take a pain reliever, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
• Wear a snug, not tight, wrist splint at night. You can find these over the counter at most drugstores or pharmacies.
• Avoid sleeping on the hands.

If pain, numbness or weakness recurs and persists, see your provider.

Alternative medicine

Integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your provider before trying any complementary or alternative treatment.

• Yoga. Yoga postures designed for strengthening, stretching and balancing the upper body and joints may help reduce pain and improve grip strength.
• Hand therapy. Early research suggests that certain physical and occupational hand therapy techniques may reduce symptoms of carpal tunnel syndrome.
• Ultrasound therapy. High-intensity ultrasound can be used to raise the temperature of a targeted area of body tissue to reduce pain and promote healing. Research shows inconsistent results with this therapy, but a course of ultrasound therapy over several weeks may help reduce symptoms.

Preparing for your appointment

Here's some information to help you get ready for your appointment and what to expect from the provider.

What you can do

• Take note of when your symptoms are at their worst. Does any particular activity seem to make them worse, or do you notice them at a particular time of day?
• Keep track of the things you've tried to make the symptoms better.
• Write down the medications you've taken to manage your symptoms.

What to expect from your doctor

Your provider will usually want to know:

• How long you've had the problem.
• If it came on suddenly or developed over time.
• If it's getting better, worse or staying the same.
• If there are certain activities that seem to cause it, make it worse or make it better.

What you can do in the meantime

If you think you may have carpal tunnel syndrome, there are some simple things you can do before you see a provider for the first time.

First, try to determine whether any activities seem to make it worse, and change how you do those or avoid them if possible. For example, if driving seems to cause symptoms, try changing the position of the hands on the steering wheel.

Also, although there is some cost involved, there is no harm in trying a wrist splint at night to see if that helps the symptoms.