American Medical Association Family Medical Guide - American Medical Association [441]
Symptoms
The symptoms of carpal tunnel syndrome usually appear gradually over weeks or months and include tingling, a burning sensation, and intermittent numbness in part of one or both hands, often accompanied by pain in the fingers that shoots up the forearm from the wrist. The pain is generally worse at night. In severe cases, a person with carpal tunnel syndrome may develop permanent numbness and a weak grip. In ulnar tunnel syndrome, the tingling, burning, and numbness occur along the ulnar nerve.
Diagnosis
To diagnose carpal tunnel syndrome, your doctor will ask you questions about any activities that could be causing the disorder and will perform a thorough physical examination to rule out other medical conditions. He or she may ask you to do some simple maneuvers with your hand and wrist to see if the movements cause symptoms. Although X-rays are not useful in diagnosing carpal tunnel syndrome, your doctor may order X-rays to rule out other disorders, such as arthritis or fractured bones. You are likely to have diagnostic tests such as a nerve conduction velocity test (to measure how fast your nerves transmit impulses) and electromyography (to evaluate your muscle activity).
Repetitive Stress Injuries
Chronic upper limb pain syndrome, cumulative trauma disorder, overuse syndrome, repetitive motion disorder, repetitive strain syndrome, and repetitive stress disorder are general terms for injuries to part of the hand or arm caused by repetitive movements of the wrist or hand. These disorders can affect nerves, muscles, tendons, or connective tissue. Carpal tunnel syndrome, ulnar tunnel syndrome, tendinitis (see page 984), and bursitis (see page 1002) are a few examples of repetitive stress injuries.
Treatment
The basic treatment for carpal tunnel syndrome and ulnar tunnel syndrome is to relieve the compression of the affected nerve. Varying your activities and adjusting your workstation may be enough to relieve your symptoms. Rest and limit flexing of your wrist by using a wrist splint or brace (which allows the swollen tissues to shrink and relieves pressure on the median nerve). Use over-the-counter pain relievers such as aspirin or ibuprofen. If they don’t ease symptoms, your doctor may inject a corticosteroid or other anti-inflammatory medication into your wrist to reduce inflammation and ease pain. If you still have weakness or pain, a surgeon can relieve pressure on the median nerve by opening the space for the median nerve in a minor surgical procedure.
Preventing Carpal Tunnel Syndrome
Although it is not always possible to prevent a stress injury such as carpal tunnel syndrome, the following steps can help reduce your risk:
• Lose weight if you’re overweight (excess fat in the wrist can compress the nerve).
• Get treatment for any disorder, such as arthritis, that may be contributing to your carpal tunnel syndrome.
• Switch hands frequently during tasks.
• Don’t rest your wrist on hard surfaces for long periods.
• Adjust your work position to reduce flexing of the wrists.
• Avoid bending, twisting, or extending your hands for long periods; take frequent breaks from repeated hand movements to give your hands and wrists some rest.
• Avoid working with your arms too close to or too far from your body.
• Don’t use tools that are too large for your hands.
Proper position of wrists when using a keyboard
If you use a keyboard for long periods, position your keyboard at a height at which you don’t have to bend your wrists up or down while you type. Your elbows should bend at a 90-degree angle and your forearms should be parallel to the floor. To make these adjustments, try either raising your chair or lowering your keyboard.
Trigeminal Neuralgia
Trigeminal neuralgia, also called tic douloureux, is severe facial pain resulting from a damaged trigeminal nerve, one of the major nerves in the face. The cause of trigeminal neuralgia is unknown. The