Carpal Tunnel Syndrome

Topic Overview

What is carpal tunnel syndrome?

Carpal tunnel syndrome is pain, tingling, and other problems in your hand because of pressure on the median nerve in your wrist.

The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel. The median nerve controls movement and feeling in your thumb and first three fingers (not your little finger).

See a picture of the carpal tunnel .

What causes carpal tunnel syndrome?

Pressure on the median nerve causes carpal tunnel syndrome. This pressure can come from swelling or anything that makes the carpal tunnel smaller. Things that can lead to carpal tunnel syndrome include:

• Illnesses such as hypothyroidism, rheumatoid arthritis, and diabetes.
• Pregnancy.
• Obesity.
• Making the same hand movements over and over, especially if the wrist is bent down (your hands lower than your wrists), or making the same wrist movements over and over.
• Wrist injuries and bone spurs.
• Smoking, because it can reduce blood flow to the median nerve.

What are the symptoms?

Carpal tunnel syndrome can cause tingling, numbness, weakness, or pain in the fingers or hand. Some people may have pain in their arm between their hand and their elbow.

Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. If you have problems with your other fingers but your little finger is fine, this may be a sign that you have carpal tunnel syndrome. A different nerve gives feeling to the little finger.

You may first notice symptoms at night. You may be able to get relief by shaking your hand.

How is carpal tunnel syndrome diagnosed?

Your doctor will do a physical exam and ask about your health and activities. You also may have some tests.

Your doctor will ask if you have any health problems-such as arthritis, hypothyroidism, or diabetes-or if you are pregnant. He or she will ask if you recently hurt your wrist, arm, or neck. Your doctor will want to know about your daily routine and any recent activities that could have hurt your wrist.

During the exam, your doctor will check the feeling, strength, and appearance of your neck, shoulders, arms, wrists, and hands.

Your doctor may suggest tests, such as:

• Blood tests to see if any health problems might be causing your symptoms.
• Nerve testing to find out if the median nerve is working as it should.

How is it treated?

Mild symptoms usually can be treated with home care. The sooner you start treatment, the better your chances of stopping symptoms and preventing long-term damage to the nerve.

You can do a few things at home to help your hand and wrist feel better:

• Stop activities that cause numbness and pain. Rest your wrist longer between activities.
• Ice your wrist for 10 to 15 minutes 1 or 2 times an hour. Try taking nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce swelling.
• Wear a wrist splint at night to keep your wrist in a neutral position. This takes pressure off your median nerve. Your wrist is in a neutral position when it is straight or only slightly bent. Holding a glass of water is an example of your wrist in a neutral position.

See your doctor if your symptoms do not get better after 1 to 2 weeks of home care, or if you have had bad symptoms from the start. You may need medicine for carpal tunnel syndrome or for a health problem that made you likely to get carpal tunnel syndrome.

Surgery is an option. But it's usually used only when symptoms are so bad that you can't work or do other things even after 3 to 12 months of other treatment.

During surgery, the doctor cuts the ligament at the top of the carpal tunnel. This makes more room in the tunnel and relieves pressure on the nerve. Surgery usually works to ease symptoms. But in some cases it does not completely get rid of numbness or pain.

How can you keep carpal tunnel syndrome from coming back?

To keep carpal tunnel syndrome from coming back, take care of your basic health. Stay at a healthy weight. Don't smoke. Exercise to stay strong and flexible. If you have a long-term health problem, such as arthritis or diabetes, follow your doctor's advice for keeping your condition under control.

You can also try to take good care of your wrists and hands:

• Try to keep your wrist in a neutral position.
• Use your whole hand-not just your fingers-to hold objects.
• When you type, keep your wrists straight, with your hands a little higher than your wrists. Relax your shoulders when your arms are at your sides.
• If you can, switch hands often when you repeat movements.

Frequently Asked Questions

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	Wrist care: Preventing carpal tunnel syndrome

Cause

Carpal tunnel syndrome occurs when a combination of health conditions and activities puts pressure on the median nerve as it passes through the carpal tunnel in your wrist. This pressure leads to tingling, numbness, pain, and/or weakness in parts of your hand and, sometimes, up into your arm. Anything that decreases the amount of space in the carpal tunnel, increases the amount of tissue in the tunnel, or increases the sensitivity of the median nerve can lead to carpal tunnel syndrome.

Factors that help cause carpal tunnel syndrome include:

• Conditions or illnesses that can cause or contribute to arm pain or swelling in the joints and soft tissues in the arm, or to reduced blood flow to the hands. These conditions and illnesses include obesity, rheumatoid arthritis, gout, diabetes, lupus, or hypothyroidism.
• Repeated hand and wrist movements that cause the membranes surrounding the tendons (tendon sheaths) to swell (tenosynovitis).
• Buildup of fluid (edema) in the carpal tunnel that can occur from pregnancy or such conditions as rheumatoid arthritis or diabetes.
• Broken wrist bones, dislocated bones, new bone growth from healing bones, or bone spurs. These can take up space in the carpal tunnel and put more pressure on the median nerve.
• Tumors and other growths (such as ganglions). These uncommon causes of carpal tunnel syndrome are usually benign.
• Normal wear and tear of the tissues in the hand and wrist caused by aging and repeated movements of the hand or wrist.
• Smoking, which may contribute to carpal tunnel syndrome by affecting the blood flow to the median nerve.

Carpal tunnel syndrome is a common work-related injury. Work that requires forceful or repetitive hand movements, hand-arm vibration, or working for long periods in the same or in awkward positions-especially when combined with other health conditions-may cause carpal tunnel syndrome.¹

In some cases the cause of carpal tunnel syndrome cannot be determined.

Symptoms

The most common symptoms of carpal tunnel syndrome are tingling, numbness, weakness, or pain felt in the fingers or, less commonly, in the palm. Symptoms most often occur in the parts of the hand supplied by the median nerve: the thumb, index finger, middle finger, and half of the ring finger. If your little finger is not affected, this may be a sign that the condition is carpal tunnel syndrome, because the little finger is usually controlled by a different nerve than the thumb and other fingers. See a picture of areas affected in the hand .

The symptoms of carpal tunnel syndrome often occur in both hands, but symptoms are usually worse in one hand than the other. You may first notice symptoms at night. People with carpal tunnel syndrome can usually fall asleep, but pain or numbness may wake them up.

Mild carpal tunnel symptoms primarily affect the hand and sometimes the forearm, but they can radiate up to the shoulder. Symptoms include:

• Numbness or pain in your hand, forearm, or wrist that awakens you at night. (Shaking or moving your fingers may ease this numbness and pain.)
• Occasional tingling, numbness, "pins-and-needles" sensation, or pain. The feeling is similar to your hand "falling asleep."
• Numbness or pain that gets worse while you are using your hand or wrist, especially when gripping an object with your hand or bending (flexing) your wrist.
• Occasional aching pain in your forearm between your elbow and wrist.
• Stiffness in your fingers when you get up in the morning.

With moderate or severe carpal tunnel symptoms, you may have numbness or reduced strength and grip in your fingers, thumb, or hand. It may be difficult to:

• Do simple hand movements, such as brushing your hair or holding a fork. You may accidentally drop objects.
• Pinch an object between your thumb and first finger (loss of pinch strength).
• Use your thumb while doing simple tasks such as opening a jar or using a screwdriver. With long-lasting carpal tunnel syndrome, the thumb muscles can get smaller and weaker (atrophy).

Not all pain in the wrist or hand is caused by carpal tunnel syndrome. There are many other conditions with similar symptoms.

What Happens

The tingling, numbness, and pain of carpal tunnel syndrome usually develop gradually. Symptoms often get worse if you do not stop or change an activity that is helping to cause the condition.

In the early stages of carpal tunnel syndrome, you may sometimes lose some feeling in your hand. Most mild cases of carpal tunnel syndrome get better with treatment. Usually there is no permanent damage to the median nerve. Your symptoms may improve by themselves when:

• Fluid buildup decreases, such as after pregnancy.
• You change or stop the activity that has caused your carpal tunnel syndrome.
• Other health problems that cause or contribute to your carpal tunnel symptoms improve.

Carpal tunnel syndrome can eventually lead to constant numbness in the fingers or hand and some loss of strength and coordination. Nonsurgical treatment may still be helpful at this point.

Long-standing carpal tunnel syndrome can cause:

• A loss of feeling and coordination in the fingers and hand. The thumb muscles can become weak and waste away (atrophy), making it difficult to grip or hold objects.
• Permanent damage to the median nerve that results in difficulty using the hand. A damaged nerve may require surgery, which may not completely restore the feeling and coordination to the fingers and hand.

When compared with other illnesses and injuries, carpal tunnel syndrome is one of the most common causes of absence from work.

What Increases Your Risk

Carpal tunnel syndrome can result from any combination of health conditions and physical activities that increase pressure on the median nerve as it passes through the wrist. Risk factors for carpal tunnel syndrome include:

• Health problems or illnesses that can cause arm pain, swelling in the joints and soft tissues in the arm, or reduce the blood flow to the hands. These include obesity, rheumatoid arthritis, diabetes, lupus, hypothyroidism, and multiple sclerosis.
• Age and being female. Women between the ages of 40 and 60 have the highest risk. Pregnant women near the end of their pregnancies often develop temporary symptoms when they retain fluid. Women taking birth control pills, going through menopause, or taking estrogen are also thought to be at risk.
• Activities that require repeated motions, especially in awkward positions. These movements might be related to work, home activities, hobbies, or sports.
• Smoking, which may contribute to carpal tunnel syndrome by affecting the blood flow to the median nerve.
• Forceful or prolonged activities such as clenching your hands or routinely driving long distances.

The most important step in controlling carpal tunnel syndrome is to stay fit and in good overall health. But if you suspect that certain activities at your workplace are helping to cause tingling, numbness, weakness, and pain in your fingers or hand, make some changes now. For example, prolonged and forceful hand movement or using vibrating machinery may contribute to symptoms of carpal tunnel syndrome. Talk to your human resources department about different ways of doing your job, changes in your equipment, or having an ergonomic consultation if you notice these symptoms. For more information, see the topic Office Ergonomics.

When To Call a Doctor

Call 911 or go to an emergency room immediately if you notice sudden loss of feeling in your arm.

Call your doctor if you:

• Have tingling, numbness, weakness, or pain in your fingers or hand that keeps coming back or that has not gone away after 2 weeks of home treatment.
• Have gradually developed little or no feeling in your fingers or hand.
• Cannot do simple hand movements, or you accidentally drop things.
• Cannot pinch your thumb and index finger together, or your pinch is weak.
• Cannot use your thumb normally (diminished thumb strength).
• Have problems at work because of pain in your fingers or hand.

Watchful Waiting

You can treat mild symptoms of wrist and hand pain or numbness at home. You may try home treatment for 1 to 2 weeks before calling your doctor.

Who To See

For the evaluation of symptoms, you may first want to consult the doctor who provides care for your other health conditions, especially conditions that may be contributing to carpal tunnel syndrome. (Health conditions such as rheumatoid arthritis, hypothyroidism, or diabetes can all lead to carpal tunnel syndrome.) Or, you may choose to see:

• A family medicine doctor.
• An internist.
• An occupational medicine specialist.

For further testing or evaluation, see:

• An orthopedic surgeon (orthopedist).
• A neurologist.
• A hand surgeon.
• A rheumatologist.
• A physiatrist.

For treatment, see:

• An orthopedic surgeon.
• A physical or occupational therapist specializing in hands or overuse injuries.
• A specialist who identifies workplace situations that contribute to repetitive-motion injuries (an ergonomist).
• A hand surgeon.

For surgery, see:

• An orthopedic surgeon.
• A hand surgeon.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Carpal tunnel syndrome is usually diagnosed from the results of a:

• Medical history, including any medical problems or illnesses, prior injuries, current symptoms, or daily activities that may be causing your symptoms.
• Hand diagram. You may be asked to help fill in a diagram of your hand to show where you have numbness, tingling, or pain.
• Physical exam, including the tests for Tinel's sign, Phalen's sign, and two-point discrimination. Although many other tests have been developed for diagnosing carpal tunnel syndrome, there is no convincing evidence of their accuracy.²

Additional testing

If your symptoms are severe, if nonsurgical treatment has not improved symptoms, or if your symptoms are not clearly caused by carpal tunnel syndrome, your doctor may recommend:

• Nerve testing (electromyogram [EMG] and nerve conduction studies), to evaluate any loss of normal functioning in the median nerve. Nerve testing for carpal tunnel syndrome is used in specific situations, such as when surgery is being considered or the diagnosis is unclear.
• X-rays, to check for bone problems caused by past injury, arthritis, recently broken or dislocated bones, or tumors. X-rays are not used to diagnose carpal tunnel syndrome, but they can be helpful for identifying signs of arthritis or an old or new wrist or neck injury that may be contributing to your symptoms.
• Ultrasound, to look at the size of the median nerve. It is inexpensive, comfortable, and quick. But its use for carpal tunnel syndrome diagnosis is still unproved and relatively uncommon.
• MRI (magnetic resonance imaging), to look for swelling of the median nerve, narrowing of the carpal tunnel, or problems with circulation of blood through the carpal tunnel.
• Blood tests, which are sometimes done to check for a thyroid problem, rheumatoid arthritis, or other medical problem. If the cause of your symptoms is unclear and your medical history suggests other possible conditions, your doctor may order blood tests.

Treatment Overview

The goal of treatment for carpal tunnel syndrome is to allow you to return to your normal function and activities and to:

• Address other health conditions if they are making your symptoms of carpal tunnel syndrome worse.
• Reduce any inflammation of tissues in the wrist that puts pressure on the median nerve.
• Determine the causes of your carpal tunnel symptoms. You can then identify whether there are activities for you to avoid or do differently and ways you can help prevent the condition.
• Prevent nerve damage and loss of muscle strength in your fingers and hand.

Treatment for carpal tunnel syndrome is based on the seriousness of the condition, whether there is any nerve damage, and whether other treatment has helped. Treatment options include treatment without surgery (nonsurgical treatment) or with surgery.

• If treated early, carpal tunnel symptoms usually go away with nonsurgical treatment.
• If your symptoms are mild, with occasional tingling, numbness, weakness, or pain, 1 to 2 weeks of home treatment are likely to relieve your symptoms.
• If home treatment does not help, or if your symptoms are more severe (including the loss of feeling in your fingers or hand, or the inability to perform simple hand movements such as holding objects or pinching), have your doctor examine you and recommend treatment.

Nonsurgical treatment

If your symptoms are not severe, expect your doctor to recommend nonsurgical treatment to see whether symptoms improve. Nonsurgical treatment includes:

• Evaluating any other medical problems that might contribute to carpal tunnel syndrome, and changing your treatment for those problems if necessary.
• Changing or avoiding activities that may be causing symptoms, and taking frequent breaks from repetitive tasks.
• Wearing a wrist splint to keep your wrist straight, usually just at night. See a picture of a wrist splint .
• Using nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation. Although studies have not shown NSAIDs to be effective for carpal tunnel syndrome, they may help relieve your symptoms.
• Learning ways to protect your joints as you go through your daily activities.

In some cases, oral corticosteroids or corticosteroid injections into the carpal tunnel may be considered if other methods to reduce inflammation are not successful.

Surgical treatment

Surgery is sometimes recommended when other treatment has not helped, if a carpal tunnel condition has continued for a long time, or if there is nerve damage or the risk of nerve damage. Surgery involves cutting the ligament that forms the roof of the carpal tunnel. This relieves the pressure on the median nerve, which eases or ends the symptoms of carpal tunnel syndrome.

See a picture of the ligament involved in carpal tunnel release surgery .

Surgery is usually successful. In some cases it does not completely relieve the numbness and pain in the fingers or hand. This may be the case if there has been permanent nerve damage caused by long-standing carpal tunnel syndrome or by other health problems such as diabetes.

Should I have surgery for carpal tunnel syndrome?

Prevention

Because carpal tunnel syndrome is usually caused by multiple factors-including health problems and activities-the most important step in preventing it is to take good care of your general health. This includes staying at a healthy weight, not smoking, and getting regular exercise. Other steps to prevent carpal tunnel syndrome include the following:

• Keep your arm, hand, and finger muscles strong and flexible.
• Stop any activity that you think may be causing finger, hand, or wrist numbness or pain.
• Use hand and wrist movements that spread the pressure and motion evenly throughout your hand and wrist.
• Switch hands and change positions often when you are doing repeated motions. Take breaks and rest your hands.
• Use correct posture.
• Restrict your salt intake if you tend to retain fluid.
• Wear a wrist splint to keep your wrist in a neutral position and to reduce the stress on your fingers, hand, or wrist at times when you cannot control your wrist motion, such as while sleeping. See a picture of a wrist splint .

Wrist care: Preventing carpal tunnel syndrome

If you feel that certain work activities are causing finger, hand, or wrist numbness or pain, talk to your human resources department for information about different ways of doing your job, changes in your equipment, other job assignments, or the possibility of an ergonomics evaluation of your work space and procedures.

In daily routines at home or while doing hobbies, consider changing activities in which you make repeated finger, hand, or wrist movements. Train yourself to use other positions or techniques that will not stress your hand or wrist.

Home Treatment

Home treatment for carpal tunnel syndrome:

• Can ease pain and prevent further or permanent damage to your median nerve.
• May completely relieve your symptoms if you start treatment when symptoms first occur.

If you have mild symptoms, such as occasional tingling, numbness, weakness, or pain in your fingers or hand, follow these steps to reduce inflammation:

• Rest your fingers, hand, and wrist. Stop activities that you suspect are causing numbness and pain.
• Ice your wrist for 10 to 15 minutes at a time, as often as once or twice an hour, and take nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce swelling. Although studies have not shown NSAIDs to be effective for carpal tunnel syndrome, they may help you to relieve symptoms.
• Wear a wrist splint at night to keep your wrist in a neutral position and relieve pressure on your median nerve. See a picture of a wrist splint .

Wrist care: Preventing carpal tunnel syndrome

When your pain is gone, begin exercises for flexibility and strength for your arm and wrist. Learn the best positions and posture for hand and wrist movements.

Medications

Medicine is often used to treat symptoms of carpal tunnel syndrome. Medicine may relieve swelling, inflammation, and pain in the wrist or hand. Reducing swelling in the wrist will relieve pressure on the median nerve in the carpal tunnel and relieve carpal tunnel symptoms.

Medication Choices

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used medicines for carpal tunnel syndrome. NSAIDs relieve pain and inflammation and are available with or without a prescription. But a review of research suggests that NSAID treatment for 2 and 4 weeks may not improve carpal tunnel symptoms. NSAIDs may be most effective if the tendon is inflamed.³ Although studies have not shown NSAIDs to be effective for carpal tunnel syndrome, they may help relieve your symptoms.

Corticosteroids may be an effective treatment option when NSAIDs do not effectively relieve pain and inflammation.³ But corticosteroids are powerful anti-inflammatory medicines and have side effects that should be considered. Corticosteroids can be taken in pill form or injected into the wrist by a doctor.

What To Think About

Medicine should be used with other measures (such as ice, rest, and splints) to reduce pain and inflammation.

Corticosteroids:

• Usually are not used until nonsurgical treatments (such as rest, ice, splints, and anti-inflammatory medicines) have been tried for several weeks with no improvement.
• Often provide temporary relief (for several weeks or more). Injected corticosteroids usually provide longer-lasting results than those taken by mouth (oral), but oral or injected medicines rarely provide permanent relief from carpal tunnel symptoms.
• Must be used with caution because both oral and injected forms have potentially serious side effects.

Surgery

Most people with carpal tunnel syndrome are treated without surgery. Surgery is considered only when:

• Symptoms have not improved after a long period of nonsurgical treatment. In general, surgery is not considered until after 3 to 12 months of nonsurgical treatment. But this assumes that you are having ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery more urgent.
• Severe symptoms restrict normal daily activities, such as when there is a persistent loss of feeling or coordination in the fingers or hand, no strength in the thumb, or when sleep is severely disturbed by pain.
• There is damage to the median nerve (shown by nerve test results and loss of hand, thumb, or finger function) or a risk of damage to the nerve.

Carpal tunnel release surgery is used to reduce the pressure on the median nerve in the wrist. This is done by cutting the ligament that forms the top of the carpal tunnel. Cutting this ligament relieves pressure on the median nerve. Any other tissue (such as a tumor) that may be putting pressure on the median nerve can also be removed during surgery.

Should I have surgery for carpal tunnel syndrome?

After surgery, it is important to avoid any activities that may have caused carpal tunnel syndrome-or change the way you do them.

Surgery Choices

The most common surgery for relieving carpal tunnel symptoms involves cutting the transverse carpal ligament to relieve pressure on the median nerve in the wrist. Two approaches for this surgery are:

• Open carpal tunnel release surgery, which allows the doctor to see more of the inner tissues, including the full width of the transverse carpal ligament where it is to be cut. Open surgery requires an incision in the palm and wrist, which disturbs more of the tissues in the hand, and requires a longer recovery period. It leaves a larger, potentially more bothersome scar than does endoscopic surgery. See a picture of open carpal tunnel surgery .
• Endoscopic carpal tunnel release surgery, which requires only a small incision at the wrist (single-portal technique) or at the wrist and palm (two-portal technique), and which disturbs less tissue in the hand. Recovery is quicker than with open surgery. And the scars heal more quickly, are smaller, and tend to be less painful at 3 months after surgery.⁴ There has been a slightly higher rate of reoperation after endoscopic carpal tunnel surgery.⁵ See a picture of endoscopic carpal tunnel surgery .

Some surgeons are now performing small- or mini-open release surgery. This requires a smaller incision than standard open carpal tunnel release surgery to minimize healing time and scar formation, but it also allows the surgeon to view the ligament directly during the surgery to minimize danger to the nerve itself. This procedure may be promising, but there are few studies comparing it to the open carpal tunnel or endoscopic procedures at this time.

What To Think About

When surgery is considered necessary to treat severe carpal tunnel syndrome, it is usually successful in relieving symptoms.

Nerve tests (nerve conduction velocity test and electromyogram) are usually completed before surgery is done. Surgery is more likely to be successful if the results from nerve testing point to carpal tunnel syndrome.

Unless carpal tunnel symptoms become intolerable, a pregnant woman should delay surgery until after childbirth. After delivery, symptoms often disappear without treatment when pregnancy-related fluid buildup is relieved.

There are many health problems, such as rheumatoid arthritis or diabetes, that can cause symptoms similar to carpal tunnel syndrome. If you have a health problem that causes severe carpal tunnel symptoms or makes symptoms worse:

• Ongoing treatment for that problem is necessary to help control those symptoms.
• Surgery may help prevent median nerve damage and give you partial relief from carpal tunnel symptoms.

Your decision about whether to use open or endoscopic surgery depends on your doctor's experience with the procedures. Endoscopic carpal tunnel surgery uses very technical equipment and is most successful when the doctor has done the procedure many times.

Other Treatment

Other treatments for carpal tunnel syndrome include:

• Physical therapy techniques, such as ultrasound, hydrotherapy, and stretching and range-of-motion exercises. In some clinics, these may be done by an occupational therapist.
  • Ultrasound therapy uses high-pitched sound waves to create heat, which may help reduce pain in the soft tissues (such as the tendons).
  • Hydrotherapy involves immersing the wrist in hot water for 3 minutes, then cold water for 3 minutes. This type of hydrotherapy (contrast hydrotherapy) increases circulation to the wrist.
• Wrist splints. In mild cases of carpal tunnel syndrome, rest and wearing a wrist splint at night may be enough to relieve symptoms. Wrist splints keep the wrist from bending and minimize or prevent pressure on the median nerve. Wrist splints are designed for different purposes such as for certain jobs or for wearing at night. Splints are most effective if they are used as soon as symptoms are noticed.
• Retraining (learning new ways of doing things), and ergonomic considerations (such as having your body in the correct posture and position and using equipment that is right for your strength and ability). Retraining and ergonomic considerations may not only relieve the symptoms of carpal tunnel syndrome but also may prevent them from coming back.

Complementary and alternative treatments

Complementary and alternative treatments are sometimes used to help with the symptoms of tingling, numbness, weakness, or pain felt in the fingers or hand. Some of these treatments include:⁶

• Acupuncture, which has been suggested as a useful treatment for some of the symptoms of carpal tunnel syndrome. Because it is commonly used, the U.S. National Institutes of Health is currently studying the effectiveness of acupuncture for treating carpal tunnel syndrome.
• Yoga, which can be helpful in relieving pain in the hand.
• Manipulation therapies, such as chiropractic, which involve realignment of joints and bones by twisting, pulling, or pushing movements in the wrist and in the forearm, upper arm, shoulder, upper back, and neck.
• Vitamin B6, which may help prevent or reduce carpal tunnel symptoms. Small studies have produced mixed results. High doses of vitamin B6 can cause nerve problems (neuropathy). Talk to your doctor before using vitamin B6 supplements.

Other Places To Get Help

Organizations

Related Information

• Office Ergonomics

References

Citations

1. Katz JM, Simmons BP (2002). Carpal tunnel syndrome. New England Journal of Medicine, 346(23): 1807-1812.

2. Massy-Westropp N, et al. (2000). A systematic review of the clinical diagnostic tests for carpal tunnel syndrome. Journal of Hand Surgery, 25(1): 120-127.

3. Ashworth N (2007). Carpal tunnel syndrome, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

4. Trumble TE, et al. (2002). Single-portal endoscopic carpal tunnel release compared with open release. Journal of Bone and Joint Surgery, 83-A(7): 1107-1115.

5. Amadio P. (2004). What's new in hand surgery. Journal of Bone and Joint Surgery, 86-A(2): 442-448.

6. Lewis DC (2006). Carpal tunnel syndrome. In JE Pizzorno Jr, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 2., pp. 1557-1561. St. Louis, Missouri: Churchill Livingstone Elsevier.

Other Works Consulted

• American Academy of Orthopaedic Surgeons (2007). Clinical guideline on diagnosis of carpal tunnel syndrome. Available online: www.aaos.org/Research/guidelines/CTSdiagnosisguide.asp.

• American Academy of Orthopaedic Surgeons (2008). Clinical practice guideline on the treatment of carpal tunnel syndrome. Available online: www.aaos.org/Research/guidelines/CTStreatmentguide.asp.

• Bednar MS, Light TR (2006). Disorders of the nerves of the hand. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 559-567. New York: McGraw-Hill.

• El Miedany YM, et al. (2004). Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: Substantive or complementary tests? Rheumatology (Oxford), 43(7): 887-895.

• Goodyear-Smith F, Arroll B (2004). What can family physicians offer patients with carpal tunnel syndrome other than surgery? A systematic review of nonsurgical management. Annals of Family Practice, 2(3): 267-273.

• Kele H, et al. (2003). The potential value of ultrasonography in the evaluation of carpal tunnel syndrome. Neurology, 61(3): 389-391.

• Nakamichi K, Tachibana S (2002). Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy. Muscle and Nerve, 26(6):798-803.

• National Institute of Neurological Disorders and Stroke (2008). Carpal tunnel syndrome fact sheet. Bethesda, MD: National Institutes of Health. Available online: http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm?css.

• Palmer KT, et al. (2007). Carpal tunnel syndrome and its relation to occupation: A systematic literature review. Occupational Medicine, 57(1): 57-66.

• Piazzini DB, et al. (2007). A systematic review of the conservative treatment of carpal tunnel syndrome. Clinical Rehabilitation, 21(4): 299-213.

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