Median nerve dysfunction; Median nerve entrapment
Carpal tunnel syndrome is a condition in which there is excessive pressure on the median nerve. This is the nerve in the wrist that allows feeling and movement to parts of the hand. Carpal tunnel syndrome can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.
Typing all day on a computer keyboard can be tough on your wrists. If you type for hours at a time, day after day, eventually you may really start to feel some discomfort. The numbness, pain, and tingling you feel in your hands and wrists may be carpal tunnel syndrome, and it can have such a big effect on your life that you may eventually need surgery to treat it. Doing any repetitive motion with your hands, whether it's typing, sewing, driving, or writing, can cause carpal tunnel syndrome. The condition gets its name from an area in your wrist called the carpal tunnel. Running through this tunnel is the median nerve, which sends feeling to your palm and most of your fingers. When you do the same task over and over again, especially flexing and extending the wrist, you put pressure on the median nerve. Over time, it swells up inside the carpal tunnel until it's so tight in there that the nerve gets pinched. The classic symptoms of carpal tunnel syndrome are numbness and tingling in your hand, including the thumb, index, middle, and half of the ring finger. The discomfort is usually worse at night. And anytime you may not be able to grip things as tightly in the affected hand, and you can feel pain that may stretch all the way from the wrist to your elbow. Your doctor can run tests on your hand to confirm that your numbness, weakness, and pain are due to carpal tunnel. You may also have nerve conduction studies, or tests of the muscles. If you're feeling a lot of discomfort from carpal tunnel wearing a wrist splint especially at night could help. In addition, short term oral or injected glucocorticoid medications can help by reducing swelling. Studies have also shown some benefit from physical or occupational therapy techniques, and joga. About half of the people with carpal tunnel though will eventually need a procedure called carpal tunnel release to lift pressure off the pinched nerve. Surgery is a more permanent solution, but whether it works depends on how severe the nerve damage is, and how long you've had it. You may not be able to completely avoid the repetitive flexing or extending the wrist that gave you carpal tunnel in the first place, especially if it's part of your job. But, you can make some adjustments, for example, by using special devices like a cushioned mouse pad, wrist braces, or a raised keyboard, to relieve the pressure on your wrists. Take occasional breaks whenever you're going to be typing or doing any other repetitive task for long periods of time. And if you are having any numbness, tingling, or pain in your hands or wrists, see your doctor sooner rather than later. Letting carpal tunnel syndrome go untreated could leave you with a permanently damaged nerve.
The median nerve provides feeling and movement to the thumb side of the hand. This includes the palm, thumb, index finger, middle finger, and thumb side of the ring finger.
The area in your wrist where the nerve enters the hand is called the carpal tunnel. This tunnel is normally narrow. Any swelling can pinch the nerve and cause pain, numbness, tingling or weakness. This is called carpal tunnel syndrome.
Some people who develop carpal tunnel syndrome were born with a small carpal tunnel.
Carpal tunnel syndrome can also be caused by making the same hand and wrist motion over and over. Using hand tools that vibrate may also lead to carpal tunnel.
Studies have not proved that carpal tunnel is caused by typing on a computer, using a mouse, or repeating movements while working, playing a musical instrument, or playing sports. But, these activities may cause tendinitis or bursitis in the hand, which can narrow the carpel tunnel and lead to symptoms.
Carpal tunnel syndrome occurs most often in people ages 30 to 60. It is more common in women than men.
Other factors that may lead to carpal tunnel syndrome include:
Symptoms may include any of the following:
During a physical exam, your health care provider may find:
Tests that may be ordered include:
Your provider may suggest the following:
Changes you can make in your workplace to reduce the stress on your wrist include:
Medicines used to treat carpal tunnel syndrome include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. Corticosteroid injections given into the carpal tunnel area may relieve symptoms for a period of time.
Carpal tunnel release is a surgical procedure that cuts into the ligament that is pressing on the nerve. Surgery is successful most of the time, but it depends on how long you've had the nerve compression and its severity.
Symptoms often improve without surgery. But more than half of cases eventually need surgery. Even if surgery is successful, full healing can take months.
If the condition is treated properly, there are usually no complications. If untreated, the nerve can be damaged, causing permanent weakness, numbness, and tingling.
Call for an appointment with your provider if:
Use tools and equipment that are properly designed to reduce the risk of wrist injury.
Ergonomic aids, such as split keyboards, keyboard trays, typing pads, and wrist braces, may be used to improve wrist posture during typing. Take frequent breaks when typing and always stop if you feel tingling or pain.
Calandruccio JH. Carpal tunnel syndrome, ulnar tunnel syndrome, and stenosing tenosynovitis. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 76.
Zhao M, Burke DT. Median neuropathy (carpal tunnel syndrome). In: Frontera, WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 36.
Last reviewed on: 5/9/2015
Reviewed by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.