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Carpal tunnel syndrome

Carpal tunnel syndrome is a hand and arm condition that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist.

A number of factors can contribute to carpal tunnel syndrome, including the anatomy of your wrist, certain underlying health problems and possibly patterns of hand use.

Bound by bones and ligaments, the carpal tunnel is a narrow passageway located on the palm side of your wrist. This tunnel protects a main nerve to your hand and the nine tendons that bend your fingers.

Compression of the nerve produces the numbness, tingling and, eventually, hand weakness that characterize carpal tunnel syndrome.

Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the tingling and numbness and restore wrist and hand function.

Symptoms Causes Risk factors Prevention

Carpal tunnel syndrome usually starts gradually with numbness or tingling in your thumb, index and middle fingers that comes and goes. This may be associated with discomfort in your wrist and hand. Common carpal tunnel syndrome symptoms include:

  • Tingling or numbness. You may experience tingling and numbness in your fingers or hand, especially your thumb and index, middle or ring fingers, but not your little finger. This sensation often occurs while holding a steering wheel, phone or newspaper or, commonly, waking you from sleeping. The sensation may extend from your wrist up your arm.

    Many people "shake out" their hands to try to relieve their symptoms. As the disorder progresses, the numb feeling may become constant.

  • Weakness. You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb's pinching muscles, which are controlled by the median nerve.

When to see a doctor

If you have persistent signs and symptoms suggestive of carpal tunnel syndrome, especially if they interfere with your normal activities and sleep patterns, see your doctor. If you leave the condition untreated, permanent nerve and muscle damage can occur.

Carpal tunnel syndrome occurs as a result of compression of the median nerve.

The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, with the exception of your little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).

In general, anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. For example, a wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis.

In many cases, no single cause can be identified. It may be that a combination of risk factors contributes to the development of the condition.

A number of factors have been associated with carpal tunnel syndrome. Although by themselves they don't cause carpal tunnel syndrome, they may increase your chances of developing or aggravating median nerve damage. These include:

  • Anatomic factors. A wrist fracture or dislocation that alters the space within the carpal tunnel can create extraneous pressure on the median nerve.

    People with smaller carpal tunnels may be more likely to have carpal tunnel syndrome.

  • Sex. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller than in men, and there may be less room for error.

    Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don't have the condition.

  • Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase your risk of nerve damage, including damage to your median nerve.
  • Inflammatory conditions. Illnesses that are characterized by inflammation, such as rheumatoid arthritis, can affect the tendons in your wrist, exerting pressure on your median nerve.
  • Alterations in the balance of body fluids. Fluid retention, common during pregnancy or menopause, may increase the pressure within your carpal tunnel, irritating the median nerve. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after pregnancy.
  • Other medical conditions. Certain conditions, such as menopause, obesity, thyroid disorders and kidney failure, may increase your chances of carpal tunnel syndrome.
  • Workplace factors. It's possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage.

    However, the scientific evidence is conflicting and these factors haven't been established as direct causes of carpal tunnel syndrome.

    Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.

There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on your hands and wrists by taking the following precautions:

  • Reduce your force and relax your grip. Most people use more force than needed to perform many manual tasks. If your work involves a cash register, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink. This way you won't have to grip the pen tightly or press as hard on the paper.
  • Take frequent breaks. Give your hands and wrists a break by gently stretching and bending them periodically. Alternate tasks when possible. If you use equipment that vibrates or that requires you to exert a great amount of force, taking breaks is even more important.
  • Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. If you use a keyboard, keep it at elbow height or slightly lower.
  • Improve your posture. Incorrect posture can cause your shoulders to roll forward. When your shoulders are in this position, your neck and shoulder muscles are shortened, compressing nerves in your neck. This can affect your wrists, fingers and hands.
  • Keep your hands warm. You're more likely to develop hand pain and stiffness if you work in a cold environment. If you can't control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.
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