Carpal tunnel syndrome

The median nerve and the tendons that flex (or curl) your fingers go through a passage called the carpal tunnel in your wrist. This tunnel is narrow. Any swelling can pinch the nerve and cause pain.

If carpal tunnel is not treated, the nerve can be damaged. This damage can cause permanent weakness, numbness, and tingling. 

Some other common symptoms of carpal tunnel syndrome include: 

• Clumsiness of the hand when gripping objects 
• Numbness or tingling in the thumb and next two or three fingers of one or both hands 
• Numbness or tingling of the palm of the hand 
• Pain that extends to the elbow 
• Pain in the wrist or hand in one or both hands 
• Problems with fine finger movements (coordination) in one or both hands 
• Wasting away of the muscle under the thumb (in advanced or long-term cases) 
• Weak grip or difficulty carrying bags (a common complaint) 
• Weakness in one or both hands 

Some other common symptoms of carpal tunnel syndrome include:

• Clumsiness of the hand when gripping objects
• Numbness or tingling in the thumb and next two or three fingers of one or both hands
• Numbness or tingling of the palm of the hand
• Pain that extends to the elbow
• Pain in the wrist or hand in one or both hands
• Problems with fine finger movements (coordination) in one or both hands
• Wasting away of the muscle under the thumb (in advanced or long-term cases)
• Weak grip or difficulty carrying bags (a common complaint)
• Weakness in one or both hands

If you or your doctor believe you may have carpal tunnel syndrome, your health care provider will conduct a physical exam. During this exam, your doctor will:

• Check the strength of your grip. 
• Tap over the median nerve at your wrist to see if this causes pain to shoot from your wrist to your hand (this is called the Tinel sign). 
• Ask about any numbness in your palm, thumb, index finger, middle finger, or thumb side of your ring finger. 
• Bend your wrist forward all the way for 60 seconds to see if it results in numbness, tingling, or weakness (this is called the Phalen test).

Tests that may be ordered include: 

• Wrist x-rays to rule out other problems, such as arthritis in your wrist 
• Electromyography (EMG, a test to check muscles and the nerves that control them) 

Nerve conduction velocity (a test to see how fast electrical signals move through a nerve) 

If you have carpal tunnel syndrome, you may want to try nonsurgical treatments first. These include anti-inflammatory medicines, workplace changes to improve your seating and how you use your computer or other equipment and wrist splints. Your health care team at Penn Medicine can suggest other therapies, including exercises and stretches that can ease symptoms and shots of corticosteroid medicine into the carpal tunnel.

If none of these treatments help, your health care team at Penn Medicine may recommend carpal tunnel release surgery. This treatment can decrease pain, nerve tingling, and numbness, and restore muscle strength. Carpal tunnel release surgery may also be needed if the muscles in your hand and wrist are getting smaller because the nerve is being pinched.