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Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a problem that affects the wrist and hand. If you have CTS, tingling and numbness can make even simple tasks hard to do. But CTS can be treated, and your symptoms can be controlled. The carpal tunnel is a narrow space inside the wrist that lets certain tendons and a major nerve pass from the forearm into the hand. With CTS, the tendon sheath may thicken and enlarge, reducing space and compressing the median nerve.

What are the symptoms?

Tingling and numbness are the most common symptoms. Some people also have hand pain or a weakened grip. At first, symptoms may wake you up at night. Later, they may occur during daily routines like driving or holding a newspaper and may become more severe over time.

How is it Diagnosed?

Your doctor will want you to describe your symptoms and will check your hand and wrist. Hand or wrist x-rays may reveal a broken bone or arthritis. You may also have a nerve conduction test and an electromyogram (EMG) which use low levels of electric current to reveal how the nerves and muscles are working.

Non-Surgical Treatment

• Taking Medication: Your doctor may suggest taking aspirin or ibuprofen. If you need to use these daily, call your doctor as they may suggest a prescription medication instead.
• Cortisone Injection: Cortisone can greatly reduce inflammation. You may feel some soreness for 24 to 48 hours, but you’re likely to have symptom relief for many weeks.
• Wearing a Splint: A splint keeps the wrist in a neutral (straight) position, preventing extreme movement that may narrow the carpal tunnel.

Surgical Treatment

Surgery may be done if symptoms become severe or if no other treatment brings relief. The goal is to relieve pressure on the median nerve by cutting (releasing) the transverse carpal ligament. Two types of surgery—open and endoscopic—are used. With open surgery, the surgeon makes one incision in your palm. With endoscopic surgery, one or two small incisions may be made, and a scope is used to operate while watching on a video screen.

Preparing for Surgery

• In the weeks before surgery, do your best to quit smoking.
• Tell your doctor about medications you take, including aspirin or other blood thinners.
• Do not eat or drink anything after midnight before surgery, or as directed.

When to Call the Surgeon

• White or pale-blue hand or nails.
• Pain not relieved by medication.
• Loss of sensation or excess swelling.
• Fever over 101°F.

After Carpal Tunnel Surgery

You will spend a few hours resting before you go home. For the safest healing, keep the following in mind:

• Keep your hand raised above heart level to reduce swelling.
• Limit hand and wrist use as instructed.
• Take any pain medication as directed.
• Do hand exercises as directed by your healthcare provider.

EDIT: Document Information

EDIT: This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. ©1999, 2001, 2010 Krames StayWell, LLC. Consultant: H. Relton McCarroll, MD, ORS, Hand Surgery. With contributions by: G. Klaud Miller, MD, ORS, Hand Surgery; Alicia Schaffer, OTR, CHT.