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Carpal tunnel syndrome - Symptoms

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of carpal tunnel syndrome.

Alternative Names

Repetitive stress injuries

Symptoms:

Symptoms of carpal tunnel syndrome usually progress gradually over weeks and months and sometimes years. Anyone with recurrent or persistent pain, numbness and tingling, or weakness of the hand should consult a doctor for a diagnosis. Symptoms often develop as follows:

Initial symptoms include pain in the wrist and palm side hand. Symptoms commonly occur in both hands. (Even when only one hand is painful, the other hand often shows signs of nerve conduction abnormalities on testing.)
Early on, the patient also usually reports numbness, tingling, burning, or some combination of symptoms on the palm side of the index, middle, and ring fingers. (Typically the fifth finger has no symptoms.) Such sensations may radiate to the forearm or shoulder.
Over time, the hand may become numb, and patients may lose the ability to feel heat and cold. Patients may experience a sense of weakness and a tendency to drop things.
Patients may feel that their hands are swollen even though there is no visible swelling. This symptom may actually prove to be an important indicator of greater CTS severity.

Symptoms may occur not only when the hand is being used but also at night when the patient is at rest. Even in cases where work is suspected as the cause, symptoms typically first occur outside of work. In fact, the disorder may be distinguished from similar conditions by pain occurring at night after going to bed.

Resources

www.aanem.org -- Advancing Association of Neuromuscular and Electrodiagnostic Medicine
www.apta.org -- American Physical Therapy Association
www.aoec.org -- The Association of Occupational and Environmental Clinics
www.aaos.org -- American Academy of Orthopaedic Surgeons
www.assh.org -- American Society for Surgery of the Hand
www.ampainsoc.org -- American Pain Society
www.iasp-pain.org -- Association for the Study of Pain
www.aan.com -- American Academy of Neurology
www.nih.gov/niams -- National Institute of Arthritis and Musculoskeletal and Skin Diseases
www.ninds.nih.gov -- National Institute of Neurological Disorders and Stroke
www.nlm.nih.gov/medlineplus/carpaltunnelsyndrome.html -- Information on CTS
www.cdc.gov/niosh/homepage.html -- National Institute for Occupational Safety and Health
www.workerscompensationinsurance.com -- Resources for injured workers
www.keybowl.com -- orbiTouch keyboard
www.ergodevices.com -- Hand and wrist support keyboard

References

Atroshi I, Gummesson C, Ornstein E, et al. Carpal tunnel syndrome and keyboard use at work: a population-based study. Arthritis Rheum. 2007;56(11):3620-3625.

Breuer B, Sperber K, Wallenstein S, et al. Clinically significant placebo analgesic response in a pilot trial of botulinum B in patients with hand pain and carpal tunnel syndrome. Pain Med. 2006;7(1):16-24.

Evcik D, Kavuncu V, Cakir T, et al. Laser therapy in the treatment of carpal tunnel syndrome: a randomized controlled trial. Photomed Laser Surg. 2007;25(1): 34-39.

Hoffman DE. Treatment of carpal tunnel syndrome: is there a role for local corticosteroid injection? Neurology. 2006;66(3):459-460.

Hui AC. A randomized controlled trial of surgery vs steroid injection for carpal tunnel syndrome. Neurology. 2005;64(12): 2074-2078.

Piazzini DB, Aprile I, Ferrara PE, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007;21(4):299-314.

Pomerance J, Fine I. Outcomes of carpal tunnel surgery with and without supervised postoperative therapy. J Hand Surg [Am]. 2007;32(8): 1159-1163.

Scholten RJ, Mink van der Molen A, Uitdehaag BM, et al. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;(4):CD003905

Wright PE. Carpal Tunnel, Ulnar Tunnel, and Stenosing Tenosynovitis. In: Canale ST, Beaty JH. (eds.) Canale & Beaty: Campbell's Operative Orthopaedics, 11th ed. Philadelphia, PA: Mosby;2007.

Reviewed last on: 5/12/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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