What is carpal tunnel syndrome? | Carpal tunnel diagnosis | Carpal tunnel treatment options | Carpal tunnel medications | Best carpal tunnel medications | Side effects of carpal tunnel | Carpal tunnel home remedies | FAQ | Resources
It starts with tingling and numbness in the hands or fingers that initially goes away, then persists. This is one of the first symptoms of carpal tunnel syndrome (CTS), a condition caused by a compressed nerve. It can be uncomfortable to live with, but there are effective treatments. For mild and moderate cases, lifestyle changes, physical therapy, and over-the-counter medications can alleviate discomfort. Even severe cases can be treated or reversed with an outpatient injection or surgery. The first step to curing it is to learn more about the problem.
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a loss of sensation in the fingers or hand caused by pressure on the median nerve in the wrist. The median nerve controls the feeling and movement of your thumb, index finger, middle finger, and ring finger. At the wrist, it passes through the carpal tunnel, a narrow opening in the side of your palm, surrounded by tendons connecting muscles to the bones of the hand. Swelling within this narrow space compresses the nerve, causing the symptoms of carpal tunnel syndrome such as tingling, numbness, and pain.
The compression of the median nerve manifests first as temporary tingling or numbness. In its mildest form, these symptoms only happen once in a while. As the swelling and compression worsen, the symptoms don’t go away. Other symptoms may appear, such as sudden pain. In its most severe form, using the hands—grasping, typing, or fine motor tasks—becomes challenging.
Carpal tunnel syndrome affects about 1 out of 20 people in the United States and is far more prevalent among women than men. The good news is that most people can achieve significant relief with a few simple medical interventions.
Reducing swelling in the affected area relieves the symptoms of carpal tunnel syndrome and often resolves the condition. People with mild or moderate carpal tunnel syndrome can reduce swelling and find adequate symptom relief with non-surgical treatments including home remedies, modifying activities, and occasionally taking over-the-counter pain relievers. More severe symptoms might require prescription medications, steroid injections, or surgery to reduce swelling in the wrist.
How is carpal tunnel syndrome diagnosed?
A healthcare provider can usually diagnose carpal tunnel syndrome by asking about your symptoms, medical history, and doing a brief physical exam. The examination may include:
- Hand examination. Your doctor looks for swelling, tenderness, and any evidence that the muscle at the base of the thumb is weakening.
- Tinel’s sign. Your physician lightly taps the median nerve at the wrist to see if it produces a tingling or numbness in the hand or fingers. Tinel’s sign is often sufficient for a diagnosis of carpal tunnel syndrome.
- Phalen’s test. During Phalen’s test, also called a wrist flexion test, you put your elbows on a table and allow your hand to fall forward and hang there. If you have carpal tunnel syndrome, you should feel numbness and tingling within 60 seconds. The more quickly this happens, the more severe the swelling.
- Square wrist sign. Your healthcare provider measures your wrist. If the ratio of the thickness (height) of the wrist to the width of the wrist is greater than 0.7, that’s a strong indicator of carpal tunnel syndrome.
- Carpal compression test. Your doctor puts pressure over the carpal tunnel area to see if this triggers numbness or tingling.
In addition to physical tests, your healthcare provider may perform nerve conduction studies, such as an electromyogram (EMG) to get a more precise diagnosis. Electromyography measures the electrical activity of a muscle when it is stimulated by a nerve. Other nerve conduction tests might be used to measure nerve conduction velocity (NCV), or how fast a nerve stimulus travels through a nerve. These tests allow for “differentiating CTS to mild, moderate, and severe stages,” explains Lenny Cohen, MD, owner of Chicago Neurological Services. “That by itself will determine what therapy option is appropriate.”
In some cases, you may need additional tests—such as an X-ray, MRI, or ultrasound. These are used primarily to rule out other medical conditions with similar symptoms, such as sprains, fractures, nerve damage, ligament damage, or a pinched nerve in the neck.
There are many causes of swelling in the wrist. Most commonly, carpal tunnel syndrome is a repetitive stress injury. Meaning, your pain is due to continuous, improper movements of the joint. However, other conditions can also cause swelling in the wrist, such as injury, rheumatoid arthritis, menopause, pregnancy, thyroid problems, pituitary problems, diabetes, birth control pills, and obesity. During your evaluation, your healthcare provider will determine what’s causing your swelling, to best treat it.
Carpal tunnel treatment options
Carpal tunnel syndrome, no matter what the severity, may resolve without formal treatment by limiting hand activity for a period of time. If it does not resolve, there are options that can help to manage the symptoms and possibly reverse the condition.
The main treatment for carpal tunnel syndrome is taking care of your wrist. Wearing a wrist splint that holds your wrist in a neutral position—even at night—is often all it takes to substantially improve symptoms. People with carpal tunnel syndrome should make lifestyle changes such as scheduling rest periods for their wrist and avoiding any activities (such as repetitive motions or using vibrating machinery) that cause swelling in the wrist. Regular stretching and mobilization exercises of the wrist also help reduce symptoms and manage the condition.
If these carpal tunnel treatments aren’t enough, over-the-counter anti-inflammatory medications, such as aspirin or ibuprofen (NSAIDs), and physical therapy may help reduce swelling and relieve symptoms. However, there is limited literature to prove that these medications have long-term symptomatic improvement of CTS.
More serious cases may require prescription anti-inflammatory drugs (such as corticosteroids) to reduce swelling or anticonvulsants (such as gabapentin) to relieve nerve pain. Your healthcare provider may recommend hand therapy with a qualified occupational or physical therapist. The hand therapist may use a variety of techniques including mobilization exercises, activity changes, hand traction, and ultrasound therapy.
Carpal tunnel release surgery, one of the most common outpatient surgeries in the U.S., can cure the condition. The surgeon cuts a carpal ligament, either in open or endoscopic surgery. This instantaneously takes the pressure off the median nerve and provides immediate relief. When the ligament grows back, it will be smaller than the original, providing more room in the carpal tunnel. Carpal tunnel surgery is fast and effective. It’s usually over in about 10 minutes.
Carpal tunnel medications
Carpal tunnel medications do not cure or reverse the condition. They provide pain relief and help to manage symptoms. Lifestyle changes, such as wearing a wrist splint and modifying activities, and sometimes surgery is required to permanently eliminate CTS.
Corticosteroids are prescription-strength anti-inflammatory drugs. They rapidly and dramatically reduce swelling. The most effective steroid treatment is a direct injection of a steroid, such as methylprednisolone or cortisone, into the carpal tunnel, where it reduces connective tissue swelling. About three in four patients will show short-term improvement following a steroid injection. One out of three patients will achieve relief from symptoms for anywhere from one to three months.
NSAIDs (non-steroidal anti-inflammatory drugs)
NSAIDs, which reduce the swelling and wrist pain, are the medication of choice for carpal tunnel syndrome. For most patients, an over-the-counter NSAID, such as ibuprofen or naproxen, is enough to control the pain and discomfort of the condition. In the short term, NSAIDs may help with symptoms; however, the long term benefits have not been proven in CTS.
Anticonvulsants are typically used to control seizures, but some anticonvulsants can effectively reduce nerve pain and are prescribed to treat severe carpal tunnel. Like NSAIDs and steroids, anticonvulsants are “only helping with symptoms and not fixing the underlying problem,” Dr. Cohen says.
Diuretics increase the amount of water and salt the body excretes. Reducing the body’s water content decreases swelling. Diuretics must be taken orally every day to stave off carpal tunnel symptoms. Some research studies show that diuretics have a limited role in CTS.
Better known as vitamin B6, pyridoxine is vital to the health of nerves, blood cells, and skin. Physicians commonly prescribe pyridoxine to treat peripheral nerve damage. Typically, a very high dose is required to treat carpal tunnel syndrome, however, overall pyridoxine has limited symptomatic benefits in CTS.
Anesthetics block nerve signals, which causes them to go numb. Some physicians may prescribe a lidocaine patch to relieve symptoms, but clinical trials are ambiguous about the effectiveness. More commonly, a steroid injection will also include an anesthetic, such as bupivacaine.
What is the best medication for carpal tunnel syndrome?
Most medications only relieve the symptoms of carpal tunnel syndrome temporarily. They do not cure the condition. The best medication is the one that provides the maximum relief of symptoms with a minimum of adverse side effects. Every person responds to medications differently. The best medication for one person may be ineffective and intolerable for others. If you find pain relief by modifying activities and wrist splinting, then you may not need medication.
|Best medications for carpal tunnel syndrome
||One 100 mg tablet every 4-6 hours
||Nausea, bleeding, dizziness
|Depo-Medrol (methylprednisolone acetate)
||1/8 to 1/2 ml injection of 80 mg/ml solution
||Mood changes, edema, increased blood pressure
||3 to 6, 300 mg capsules daily
||Headache, eye problems, coordination problems
||One 25 mg tablet once per day
||Lowered blood pressure, low electrolytes, dry mouth
||100-200 mg daily
||Decrease in vitamin B9, decreased sensation, headache
||10 mg along with a corticosteroid injection
||Low heart rate, lowered blood pressure, dizziness
The standard dosages above are from the U.S. Food and Drug Administration. Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist.
What are the common side effects of carpal tunnel medications?
There are a number of common side effects of carpal tunnel medications, and different classes of medications have different side effects. However, this is not a complete list, and it is best for you to consult with your healthcare professional for possible side effects and drug interactions based on your specific situation.
NSAIDs (non-steroidal anti-inflammatory drugs)
NSAIDs are widely available and considered safe medications. They can, however, have serious side effects in some people, especially if taken long-term. NSAIDs provide only temporary relief of carpal tunnel symptoms but give the illusion of having fixed the underlying condition. As a result, the most serious side effect of NSAIDs for people with carpal tunnel syndrome is the continuation of activities that will worsen the underlying condition. Other side effects may include stomach problems, ulcers, gastrointestinal bleeding, bruising, and bleeding problems.
Corticosteroids are prescription-strength anti-inflammatory drugs. Many people experience side effects, such as mood and behavior changes, increased appetite, weight gain, acne, thinning skin, and a rise in blood pressure. These side effects are far more likely when taking steroids orally; a corticosteroid injection will have fewer and less severe side effects. Long-term steroid use can lead to adrenal insufficiency as well as the development of diabetes Type 2.
Anticonvulsants produce a dramatic reduction of nerve pain, but they do so at a high price. For carpal tunnel syndrome, gabapentin is prescribed at high doses that are more typical for epilepsy. As a result, patients commonly experience nerve issues, such as confusion, dizziness, difficulty speaking, eye problems, and loss of coordination. Like steroids, anticonvulsants are used only as a temporary measure.
Diuretics have several potentially severe side effects. These drugs remove water from the body and also eliminate electrolytes, such as sodium, potassium, and magnesium. Low electrolyte balances can cause serious health issues. In addition, diuretics can cause dehydration and change the pH of the blood, which can be dangerous. Most of the minor side effects of diuretics, such as low blood pressure, dry mouth, dry eyes, dizziness, and weakness, are due to one of these effects.
Pyridoxine is an essential nutrient that occurs naturally in the body. Pyridoxine often is prescribed in high doses for carpal tunnel syndrome, and these high doses may cause a decrease in folic acid (vitamin B9) in the body. Patients might notice a loss of appetite, decreased sensation, and numbness. Taking large doses of pyridoxine over time can cause permanent nerve damage.
Anesthetics are a short-term solution and can be risky, so the most common method for using them as a carpal tunnel treatment is to inject an anesthetic, such as lidocaine or bupivacaine, directly into the wrist along with a steroid to provide symptom relief. Aside from burning and stinging, the most common side effects of anesthetics are central nervous system problems, like dizziness or confusion. They can also cause heart problems, such as abnormal heart rhythms and chest pain.
What are the best home remedies for carpal tunnel?
Most people with mild to moderate carpal tunnel syndrome find adequate pain relief—and even reverse the condition—without medication by modifying activities and wearing a wrist splint. Even if you’re taking medication, you need to include a rigorous regimen of lifestyle changes for carpal tunnel treatment to succeed.
1. Wear a wrist splint
Wrist splints are the first-line treatment for carpal tunnel syndrome. A wrist splint holds the wrist in a neutral position (without flexion), and prevents movement. A splint helps relieve symptoms, prevents further damage to the nerve, and allows for healing. In particular, wearing a wrist splint while sleeping will keep the wrist from bending or flexing during the night.
2. Modify activities
For the carpal tunnel to heal, you must rest your wrist. Limit activities that use your hands and avoid anything that may cause further swelling, such as repetitive movements, lifting objects, using tools that vibrate, or typing. If you must use your hands, schedule breaks every 10 or 15 minutes to give your wrist a chance to rest and your muscles to relax.
3. Ice the wrist
Similar to many injuries, ice can relieve the swelling and pain from carpal tunnel syndrome. Use an ice pack or soak your wrist in ice water for 10 or 15 minutes every hour to reduce swelling.
4. Do regular wrist stretches and exercises
There are some exercises that will stretch and relax the structures within the carpal tunnel. The simplest is to regularly shake your hands the way you do to dry them after washing. The American Academy of Orthopaedic Surgeons also advises a program of median nerve and tendon gliding exercises that will help the median nerve move more freely within the carpal tunnel.
5. Incorporate more vitamin B6
One study found that vitamin B6 improved carpal tunnel syndrome symptoms in mild to moderate cases. Green peas, bananas, and avocado are some sources of vitamin B6, but you might also ask your healthcare provider about taking a vitamin B6 supplement.
Frequently asked questions about carpal tunnel
How do you get carpal tunnel?
Carpal tunnel syndrome arises from swelling in the wrist that compresses the median nerve. Repetitive stress, injuries to the wrist, fluid retention, thyroid disorders, high blood pressure, arthritis, and even certain sleeping positions can cause carpal tunnel syndrome to develop or worsen.
What does it feel like when you have carpal tunnel syndrome?
At first, carpal tunnel syndrome produces tingling, numbness, and possible pain in the thumb and first three fingers. As the condition worsens, those symptoms might move to the wrist and forearm.
Do I have carpal tunnel syndrome or tendinitis?
Tendinitis is the inflammation of any one of 10 tendons that pass through the wrist and is often confused with carpal tunnel syndrome. Only a healthcare professional can make a definitive diagnosis. However, tendinitis tends to produce pain near the tendon injury, whereas carpal tunnel syndrome tends to provoke pain and numbness in the thumbs and fingers. If the pinky side of the hand hurts, carpal tunnel syndrome can be ruled out.
What is the best medication for carpal tunnel syndrome?
Over-the-counter NSAIDs (ibuprofen, naproxen, aspirin) are the most common medication for mild to moderate cases of carpal tunnel syndrome. These medications may help relieve symptoms for a short duration. In severe cases, a healthcare provider may prescribe corticosteroids, anticonvulsants, diuretics, or anesthetics to alleviate symptoms. It’s important to remember that medications do not cure carpal tunnel syndrome, but rather help manage the symptoms and provide temporary pain relief.
Does carpal tunnel go away without surgery?
Carpal tunnel surgery is only used for severe cases that have damaged the nerves as measured by nerve conduction tests. Mild to moderate carpal tunnel syndrome will often resolve through activity modification and wrist splinting.
Can carpal tunnel be cured naturally?
Mild and moderate carpal tunnel syndrome often improves and eventually goes away without medications or surgery. Lifestyle changes, wrist exercises, activity modification, and (sometimes) dietary changes are enough to reduce swelling and produce a normal feeling in the hand. Severe carpal tunnel syndrome that has produced permanent damage to the median nerve requires surgery.
What is the most effective treatment for carpal tunnel syndrome?
The most universal carpal tunnel syndrome treatment for mild to moderate cases is modifying activities and wearing a wrist splint. These treatments often provide relief from symptoms and reverse the disorder. Severe carpal tunnel syndrome damages the median nerve permanently. Surgery may be required to stop the damage from progressing.
What happens if carpal tunnel syndrome goes untreated?
If a person with carpal tunnel syndrome does not make adjustments to treat the condition, it may worsen and cause permanent damage to the median nerve. Untreated severe carpal tunnel syndrome progressively limits your ability to use your hand, even for simple tasks.
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