CARPAL-TUNNEL SYNDROME

General Information

DEFINITION--A nerve disorder in the hand that causes pain and loss of feeling, especially in the thumb and first 3 fingers. It is common among people using computers and word processors.

BODY PARTS INVOLVED--Median nerve at the wrist joint; blood vessels, nerves and tendons of the hand.

SEX OR AGE MOST AFFECTED--Both sexes, but most common in women between ages 29 and 62.

SIGNS & SYMPTOMS

• Tingling or numbness in part of the hand.
• Sharp pains that shoot from the wrist up the arm, especially at night.
• Burning sensations in the fingers.
• Morning stiffness or cramping of hands.
• Thumb weakness.
• Frequent dropping of objects.
• Inability to make a fist.
• Shiny, dry skin on the hand.

CAUSES--

Pressure on the median nerve caused by swollen, inflamed or scarred tissue. The sources of pressure include:

• Repetitive motion injury (associated with continuous and rapid use of the fingers).
• Inflammation of the tendon sheaths (sometimes from arthritis).
• Fracture of the forearm.
• Sprain or dislocation of the wrist.

RISK INCREASES WITH

• Diabetes mellitus.
• Hypothyroidism.
• Menopause.
• Raynaud's disease.
• Pregnancy.
• Work that requires strong hand or wrist action (computer users, some musicians, factory workers, cashiers).
• Obesity.

HOW TO PREVENT

• Take a break at least once an hour when doing repetitive work involving hands.
• Wear a wrist brace or splint if your work involves doing repetitive work involving hands.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms. For a simple test, place the backs of your hands together with your fingers pointing straight down and your elbows pointing straight out to the side (wrists are at a 90deg. angle). If symptoms are brought on by you holding this position for one minute, you most likely have carpal-tunnel syndrome.
• Medical history and physical exam by a doctor.
• Electrophysiologic nerve tests (records electrical activity of muscles) and x-rays of the hand and wrist.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Surgery to free the pinched nerve. Provides almost complete relief from all symptoms in 95% of patients. Procedure may be done as an outpatient. (See Carpal-Tunnel Syndrome Repair in Surgery section.)

POSSIBLE COMPLICATIONS

• Permanent numbness and a weak thumb or fingers in the affected hand.
• Permanent paralysis of some of the hand and finger muscles.

PROBABLE OUTCOME--Usually curable--sometimes spontaneously, sometimes with surgery. Surgery usually needed if muscle wasting or nerve changes have developed. If pregnancy is the cause, the problem usually clears up after delivery.

How To Treat

GENERAL MEASURES--

• Conservative treatment is usually tried first.
• Discomfort improves by shaking hands or dangling arms. If you awaken at night with pain in your hand, hang it over the side of the bed; rub or shake it.
• Wearing a splint on the affected wrist may be recommended.
• For work at a computer terminal, be sure desk, keyboard and chair are at the proper height. Take a break once an hour.

MEDICATION--

• You may take aspirin or ibuprofen to reduce pain and inflammation.
• Your doctor may prescribe: Anti-inflammatory drugs to reduce inflammation. Cortisone injections at the wrist to reduce inflammation. Vitamin B-6 injections.

ACTIVITY--Stay as active as your strength allows. If surgery has been necessary, allow 2 weeks for recovery. Exercises may be prescribed for the hand.

DIET--Eat a normal, well-balanced diet.

Call Your Doctor If

Symptoms of carpal-tunnel syndrome don't disappear in 2 weeks.