What are the Symptoms of Carpal Tunnel Syndrome?
The most common symptom of carpal tunnel syndrome (CTS) is numbness or tingling sensation in your fingers and/or hands. You may experience pain in your wrists when doing certain activities such as typing, writing, using a computer keyboard, etc. The symptoms usually begin gradually over time and worsen with activity.
How Does Carpal Tunnel Cause Pain?
Carpal tunnel syndrome causes pain because it interferes with the nerves that control your muscles. These nerves are called motor neurons. When these nerves become damaged, they no longer function properly. The result is muscle weakness or paralysis, which results in the symptoms of CTS.
Causes of Carpal Tunnel Syndrome: Causes of CTS include:
Injury to the nerves that control your wrist muscles. A broken bone, a severe fall, or other trauma can cause damage to these nerves. Other possible causes include: Trauma from falling down stairs, being hit by a car, having a sports injury, or getting into an accident.
Broken bones in the hand and wrist can also cause CTS. Nerve compression caused by arthritis (a disease). This is common in people over the age of 50. Having a condition called rheumatoid arthritis, which causes swelling and pain in the joints. This may lead to loss of mobility and CTS.
Poor posture when working at a computer can also cause CTS.
Pregnancy can also cause fluid retention in the hand and arms, which puts more pressure on the nerves in your wrist. This can also lead to carpal tunnel.
Older Adults Are More Prone to Carpal Tunnel Syndrome: Carpal Tunnel Syndrome is more common in people over the age of 40. That’s because with age, the tissues and muscles in your hands and arms begin to weaken. In addition, there are medical conditions that arise in older people that can cause CTS.
Danger Signs for Carpal Tunnel Syndrome: If you have any of the following danger signs, seek immediate medical attention:
Numbness that spreads to your palm. Loss of muscle mass in your hand and fingers. You can no longer make a fist.
Your fingers tremble a lot. You have trouble picking up small objects. You have trouble writing.
How Common Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is the most common nerve disorder. It usually affects people between the ages of 40 and 60, especially women . For some people, symptoms will come and go. This is called intermittent carpal tunnel syndrome. For other people, the symptoms are long-term or remain constant. If you have any of these other risk factors, your chances of developing carpal tunnel syndrome are increased:
You are female. Your occupation involves using a computer. You perform the same task repeatedly at work.
You have a family history of carpal tunnel syndrome (this is more common in women). You are over the age of 40. You smoke and/or drink heavily.
For some people, there is no known cause for carpal tunnel syndrome.
How Is Carpal Tunnel Syndrome Diagnosed?
Your doctor will review your medical history and perform a physical exam. You will be asked questions about your job and hobbies to determine what activities may be putting pressure on the median nerve in your wrist. In addition, your doctor may ask about any injuries you’ve had in the past.
The physical exam may include:
Pressing on the tendons at the base of your thumb. This is to check for weakness in these tendons. Testing the strength of your grip.
This is also to see if you have weakness in your grip. Checking the skin on the back of your hand for sensitivity.
In addition, your doctor may refer you to a specialist for further evaluation. Some of these tests may include:
X-ray. This is used to look at the bones in your wrist. Ultrasound (also called sonography).
High-frequency sound waves are beamed at the tissues and organs to produce images of their structure on a video screen. Nerve conduction test. Tiny electrical charges stimulate the nerves to see how quickly the signal is conducted. This tests how well the median nerve is functioning. Electromyogram (EMG). A small needle is inserted into the muscles to check for damage to the nerve fibers.
CTS may be cured by having surgery to stretch the area where the nerve becomes compressed, or by releasing the pressure on that nerve. In the past, it was common for physicians to recommend having surgery. This is because people who had the surgery would recover and those who didn’t would continue to have symptoms.
However, with the advancement in medication and therapy, there is less need to operate. Your doctor will discuss the various treatment options with you based on your specific situation.
Carpal tunnel syndrome is a relatively common disorder that causes tingling and numbness in the fingers. It can be caused by repetitive hand movements and requires frequent activity of the hands. Carpal tunnel syndrome exercises are used to strengthen the muscles in your hands, arms, and shoulders.
They can also help to stretch and relax the tendons in your forearm and wrist to help prevent the condition from becoming worse.
While there is no cure for carpal tunnel syndrome, most people find that the symptoms can be managed with a combination of exercise, stretching, and lifestyle changes.
Carpal tunnel syndrome (CTS) is a common disorder that causes tingling and numbness in the fingers. It usually affects women aged 20-50, but may also affect men and teenagers.
The main cause is believed to be a decrease in the amount of space within the carpal tunnel of the wrist. The carpal tunnel is a narrow passageway at the base of the hand. It houses the median nerve and tendons to the fingers, which pass through it before attaching to the tips of the fingers.
The narrowing of this tunnel can be caused by:
Acute or chronic inflammation within the tunnel. This can be due to disease, injury, or other disorders such as rheumatoid arthritis or systemic lupus erythematosus.
Growth of fatty tissue within the tunnel, causing it to narrow.
Increased fluid retention in the tissue around the tunnel, again causing it to narrow.
The median nerve can also become compressed as it passes through other tight areas in the forearm. This is called a tunnel syndrome and may occur in the:
Ulnar tunnel — at the base of the wrist, affecting the little finger and half of the ring finger.
Tensor tunnel — at the wrist, affecting the thumb.
Recognizing the symptoms and realizing that you have carpal tunnel syndrome is the first step towards getting help and getting better. Do not ignore these signs!
Many, but not all, people experience tingling in their fingers–especially at night. Others may have a loss of sensation in their fingers or palms, and some have pain in their wrists or forearms. In most people, the main symptom is a sense of weakness in the hand, which may be worse when holding heavy things.
The symptoms are usually worse at night and after activity and may be relieved by shaking out the hand.
Tinel’s Sign: Percussing over the dorsum of the wrist over the radial nerve at the wrist may elicit a paresthesia in the middle finger or ring finger.
Phalen’s Sign: Repeatedly bending the wrist back and forth may produce tingling or numbness in the pinky and half of the ring finger.
Most people with CTS do not have all of these symptoms, and some may never have them at all. If you do have any of these symptoms, see a health care professional immediately–do not ignore them! Ignoring carpal tunnel syndrome can increase the severity of your condition and cause irreversible nerve damage.
If you have diabetes (over 50% of people with diabetes get CTS) or rheumatoid arthritis (20%-40% of people with RA), you are at higher risk for developing CTS.
If you smoke, you are also at higher risk–each cigarette raises your risk by 10%.
As we age, the carpal tunnel becomes more likely to develop issues due to the aging process.
Repetitive activities involving the hands, such as typing or assembly line work, make you more likely to develop CTS.
These factors indicate that there is a family predisposition to getting CTS.
It is important to avoid use of the hands in the evenings and nights. If you are a computer technician, for example, you should not do your work late at night when you are most tired and are more likely to “startle” the median nerve as it passes through the carpal tunnel.
Some people feel that there is a link between CTS and arthritis. This may explain why another common factor seems to be rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and ankylosing spondylitis.
There is also a relationship between diabetes and CTS.
Carpal tunnel syndrome is caused by repetitive movements of the hands, especially those involving flexing and extending the wrist, which results in pressure on the median nerve as it passes through the carpal tunnel.
Some people are more prone to carpal tunnel syndrome due to their job duties or hobbies.
It is important to determine what activities cause pain or loss of sensation in the median nerve area and to avoid those activities.
In most people, the main symptom of CTS is tingling or numbness in the fingers, especially at night. Sometimes, it may wake you up because the numbness or tingling is especially bad then. Usually, these symptoms are worse when you wake up in the morning and improve as the day goes on.
People with CTS also commonly experience pain in the wrist, forearm, and hand.
If the median nerve is compressed or inflamed for a long period of time (6 months or more), the muscles in that area can waste away (atrophy). This can lead to a condition called “carpal tunnel claw hand,” in which your fingers appear to be fixed in a bent position and are difficult to move. It can take several months or even years for carpal tunnel claw hand to appear.
At one time, carpal tunnel claw hand was considered to be a real problem mainly for women who used vibrating tools in factories. However, it can also affect men and women who engage in such activities as using a computer keyboard, playing a musical instrument, or doing work that requires the use of power tools.
If you experience the following symptoms, please see your doctor:
You are a young person (under 20 years of age) and have symptoms of CTS. You work at a job that requires repeated flexing of the wrists (using a hammer or a keyboard, for example). You have pain in the wrist, arm, hand, or fingers.
You have numbness in the wrist, arm, hand, or fingers. You have limited ability to move the fingers. You have weakness in the hand. You have tingling or “pins and needles” in the hand.
You may also experience some of the following symptoms:
Pain that “shoots” into the arm and even into the shoulder. Numbness that may start in the hand or wrist and travel towards the elbow (this could be a sign of carpal tunnel syndrome). A feeling of weakness in the hand when trying to grasp something or continued dropping of objects.
General weakness and/or tiredness (asthenia) or loss of stamina. You may also experience a decreased ability to perform tasks that require grasping (zereshteh in Farsi, meaning “grasping” or “gripping”). This is one of the first symptoms of repetitive motion syndrome.
Pain that radiates upwards from the wrist into the forearm and sometimes into the shoulder. Loss of sense of touch in the fingers (this could be a sign of carpal tunnel syndrome).
If you experience any of these symptoms, do not ignore them.
Sometimes, CTS is not caused by repetitive strain from work or hobbies, but by other factors.
In these cases, the median nerve may be compressed or inflamed for other reasons. For example:
If you are obese and have a large “love handle” that puts pressure on your wrist while you sleep, you may have CTS. If you have a tumor or some sort of growth on or near your wrist, it may put pressure on the nerve and cause CTS. This is a less common cause of CTS.
If you have a condition that increases the pressure of the fluid around your nerve, or if you take a medicine that does this, you may experience symptoms of CTS.
In some people, the ulnar nerve at the little finger side of the wrist may become compressed or inflamed, and this can sometimes cause symptoms similar to CTS.
The following factors put you at higher risk for developing CTS:
You are female. You are between the ages of 20 and 50. (Incidence increases with age).
You use vibrating tools at work. You are overweight. You smoke cigarettes. Your family has a history of CTS (this could be because of a genetic tendency to get certain diseases, because of the heredity nature of connective tissue disorders such as lupus, or due to other reasons). You experience ongoing or recurrent infections in your hands or arms. Your occupation involves extreme or unusual physical exertion. You damage the nerves in your wrist when you hit it against a hard object, for example. You experience injury to your wrist by punching a dashboard during a car crash.
You are more likely to get CTS if you do one or more of the following:
Use vibrating tools at work, such as grinders, sanders, pneumatic drills or other construction tools. Do a lot of assembly line work. Work with your hands in water a lot (such as a cook or a cleaner).
Use tools that require you to force your wrist into extreme extension or hyperflexion (bending backwards) such as when using a screwdriver or wrench. Work as a truck driver and are required to make constant turns of the wheel with your wrists. Repeatedly carry heavy objects with your arms outstretched.
A family history of CTS puts you at higher risk for developing the condition. Certain genetic disorders can also increase your risk of getting CTS. If your connective tissue is poorly constructed, too much stretching or tearing can occur when you use your hands a lot.
Other things that can cause damage to the nerves are direct trauma such as a hard hit on the wrist, or prolonged or intense vibration (which occurs with tools such as pneumatic drill or jackhammers).
There are several ways to test for CTS. One of the most common is called a Tinel’s Test, in which the doctor taps over the skin over the nerve at the wrist. This usually causes tingling or numbness in the little finger and half of the ring finger.
In a positive Phalen’s Test, the doctor presses on the median nerve at the base of your palm. This should cause your fingers to temporarily become weak and numb. A positive Phalen’s Test is sometimes called “dead finger”.
A blood test can be taken that measures the amount of a particular enzyme in the blood. Under normal circumstances, this enzyme is found mainly in the brain and heart. If it appears in larger amounts in other parts of the body such as the arms or legs, this may indicate damage to the nerves.
There are many treatments for CTS. There is no cure. Most treatments are intended to relieve the pain and weakness caused by the condition.
These may include:
Use of a wrist splint that keeps your wrists in a slightly bent position. Application of a heating pad or cold pack to alleviate pain. Medication such as anti-inflammatory drugs or pain relievers.
Physical therapy to maintain strength and prevent further damage. Surgery to pin the affected wrist into a fixed position and relieve pressure on the median nerve. It may be recommended only as a last resort, since it is major surgery that may produce its own set of complications.
Simplest way to avoid carpal tunnel syndrome is to take regular breaks from repetitive actions and use good working techniques. There are several ways to do your work: changing the way you use your computer mouse or keyboard, taking more frequent breaks, or changing your sitting or working position. It is important to keep yourself relaxed while working on the computer.
Place your wrists in a more neutral position (neither bent up nor down).
Move frequently – you may be more comfortable in a different position.
Don’t sit too close or too far from the monitor.
Keep the top of the monitor level with the bottom of your eyes.
Take regular breaks away from the computer.
Make sure the height of the keyboard is at elbow level when your palms are flat on the table.
Move your mouse out of the way when not using it.
Get a soft keyboard or place a rolled-up towel under your wrists when typing.
Use your keyboard more like a piano – rest your wrists on the keys as you type.
While holding down a key, move your wrists back and forth (don’t move your arms or fingers).
Wear wrist splints at night to keep your hands in a neutral position.
Strengthen your arms, shoulders, and hands.
Take an ergonomics course.
Give your eyes a rest by reading something other than computer printouts.
Give your hands and wrists a rest by using a pen or pencil.
Sources & references used in this article:
Tennis injuries: prevention and treatment: A review by DN Kulund, FC McCue III… – … American Journal of …, 1979 – journals.sagepub.com
Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome—an MRI study to reveal therapeutic mechanisms by AB Schmid, JM Elliott, MW Strudwick… – Journal of …, 2012 – Wiley Online Library
Isometric wrist exercise device by JT Glover – US Patent 5,967,947, 1999 – Google Patents
Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery by C Stevinson, VS Devaraj… – Journal of the Royal …, 2003 – journals.sagepub.com
End Your Carpal Tunnel Pain Without Surgery: A Daily 15-Minute Program to Prevent & Treat Repetitive Strain Injury of the Arm, Wrist, and Hand by K Montgomery – 1998 – books.google.com
Carpal tunnel syndrome: An investigation into the pain by MA Swartz – Professional Safety, 1998 – search.proquest.com
A review of treatment for carpal tunnel syndrome by JK Wilson, TL Sevier – Disability and rehabilitation, 2003 – Taylor & Francis
Repetitive strain injury by M Van Tulder, A Malmivaara, B Koes – The Lancet, 2007 – Elsevier
Exercise and mobilisation interventions for carpal tunnel syndrome by MJ Page, D O’Connor, V Pitt… – Cochrane Database …, 2012 – cochranelibrary.com