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Carpal Tunnel Syndrome

Definition

Carpal tunnel syndrome is a nerve disorder of the hand. It is caused by compression of the median nerve. The median nerve gets squeezed inside a narrow passage in the wrist called the carpal tunnel. This nerve provides feeling to the thumb, index and middle fingers, and half the ring finger.
Carpal Tunnel Syndrome
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Causes

Carpal tunnel syndrome is created by pressure on the median nerve. This pressure is caused by the carpal tunnel becoming narrower. The narrowing can be caused by many factors, including:

Risk Factors

Women and older adults are at greater risk for carpal tunnel syndrome.
Factors that may increase your risk of carpal tunnel syndrome include:

Symptoms

Carpal tunnel syndrome causes symptoms in one or both hands or wrists. Symptoms may include:

Diagnosis

You will be asked about your symptoms and medical history. A physical exam of your arms, wrists, and hands will be done. The exam will include tests of strength, sensation, and signs of nerve irritation or damage.
Other tests may include:

Treatment

It is important to correct whatever is causing the carpal tunnel syndrome. Sometimes making simple changes in your workplace or home may help relieve symptoms.
Treatment may also include:

Rest, Ice, Elevation, and Exercises

  • Rest your wrist by keeping it straight and decreasing activities that worsen pain.
  • Gently apply ice packs to the area.
  • Elevate the hand above your heart to reduce swelling.
  • Do exercises as directed by your healthcare provider.

A Wrist Splint

A splint will prevent extreme movements of the wrist. It is most effective when worn at night. It can help you avoid waking up with symptoms.

Medications

  • Over-the-counter pain relievers such as aspirin and ibuprofen
  • Injection of cortisone into the carpal tunnel

Surgery

Surgery may be needed if symptoms are severe, or continue after you try other treatments. The most common procedure is the carpal tunnel release .

Prevention

You may reduce your chances of getting carpal tunnel syndrome by taking these steps:

RESOURCES

American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org

American Association of Neurological Surgeons http://www.aans.org

CANADIAN RESOURCES

Canadian Centre for Occupational Health and Safety http://www.ccohs.ca

Canadian Physiotherapy Association http://www.physiotherapy.ca

References

Carpal tunnel syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed September 9, 2014.

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Carpal tunnel syndrome: how you can help your patient overcome the symptoms. Consultant. 1994.

Cartwright MS, Hobson-Webb L, et al. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012 Aug;46(2):287-93.

JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011 Apr;469(4):1089-94. ns; 2005: chap 36

Fowler JR, Gaughan JP, et al. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011 Apr;469(4):1089-94.

Hunderfund AN, Boon AJ, et al. Sonography in carpal tunnel syndrome. Muscle Nerve. 2011 Oct;44(4):485-491.

Katz RT. Carpal tunnel syndrome: a practical review. Am Fam Physician. 1994;49:1371-1379, 1385-1386.

Ly-Pen D, Andréu JL, et al. Comparison of surgical decompression and local steroid injection in the treatment of carpal tunnel syndrome: 2-year clinical results from a randomized trial. Rheumatology (Oxford). 2012 Aug;51(8):1447-54.

NINDS carpal tunnel syndrome information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/carpal%5Ftunnel/carpal%5Ftunnel.htm. Updated September 5, 2014. Accessed September 9, 2014.

O'Connor D, Page MJ, et al. Ergonomic positioning or equipment for treating carpal tunnel syndrome. Cochrane Database Syst Rev. 2012 Jan 18;1.

Page MJ, O'Connor D, et al. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012 Jun 13;6.

Rayan GM. Understanding and managing carpal tunnel syndrome. Journal of Musculoskeletal Medicine. 1999;654.

Shores JT, Lee WP. An evidence-based approach to carpal tunnel syndrome. Plast Reconstr Surg. 2010 Dec;126(6):2196-2204.

Steyers CM, Schelkun PH. Practical management of carpal tunnel syndrome. Phys Sportsmed. 1995:83.

Whitley JM, McDonnell DE. Carpal tunnel syndrome. Postgraduate Medicine. 1995;97:89-92,95-96.

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