Dear Mayo Clinic: Earlier this year, I began experiencing some pain in my right hand and wrist. I am a systems engineer and have always done a fair amount of typing at work. Now with the COVID-19 pandemic, I am working at home and spending even more time on a keyboard. I'm finding the pain has increased, and I'm also having some new tingling and numbness in my hand and wrist. I heard about carpal tunnel and was wondering if I may have it. If I do have carpal tunnel, what can I do to help or reverse it?

Answer: There are various things that can cause hand and wrist discomfort. Feelings of pins and needles, or a sensation of tingling or prickling, can occur in the hands due to pressure on nerves, which are like electrical cables that in part give feeling to your fingers.

The exact area of discomfort and symptoms will guide which condition you likely have. Are your symptoms occurring all day or only at certain times? Are you having pain only while typing?

Given the situation you describe, it's most likely you are experiencing one of two common ailments that have become more common in the age of technology. The first is a type of tendonitis known as De Quervain's tenosynovitis. This is considered an overuse injury caused by repetitive hand or wrist motion. The second possibility sounds like it could be carpal tunnel syndrome. Activities such as typing or texting, golfing, and gardening can worsen these conditions.

De Quervain's tenosynovitis affects the tendons on the thumb side of your wrist. You may have swelling in this area and pain that is exacerbated when you twist your wrist, grasp or lift something heavy like a milk jug.

Carpal tunnel syndrome is a condition that can create numbness and a sensation of tingling in your fingers. It occurs when the median nerve, which is on the palm side of the hand, is compressed or irritated in some way. Symptoms typically are limited to your thumb, index finger, middle finger and thumb side of your ring finger.

If you feel tingling along the inner aspect of your forearm down to your pinky finger, carpal tunnel is not likely the cause. Rather, it may be that you are suffering from cubital tunnel, which is irritation of a nerve by your inner elbow.

Many patients with carpal tunnel report initial symptoms at night, although as the condition progresses, carpal tunnel can cause weakness of the thumb's pinching muscles and lead to difficulties performing routine tasks. Some patients have reported numbness in their hand that is exasperated, for instance, while holding a phone or driving.

If your symptoms are related to De Quervain's tenosynovitis, using ice for swelling and taking a mild pain reliever can help with discomfort.

The best treatment, though, is to reduce the activity that is most likely causing your symptoms. While that can be challenging now, especially if you notice that your pain is exasperated while you type, consider using a voice-activated dictation system or switch fingers if you text a lot. For instance, if you most often use your thumbs to text and it has become more painful, switch to using your index fingers instead.

I also would recommend that you perform an ergonomics check of your at-home workspace. Your posture can affect how you function and develop some of these symptoms. Second, look at the position of your wrist. If you are sitting or standing at an awkward height, your wrist could be in a significantly flexed position that puts pressure on the nerves and tendons, and increases your risk for issues and symptoms.

To help alleviate your carpal tunnel like symptoms at night, try an over-the-counter splint with a metal reinforcement on the palm side. This splint will stop you from flexing your wrist and reduce irritation on the nerve.

If your symptoms progress, talk with your health care provider about next steps to confirm your diagnosis and the potential for other nonsurgical treatments, such as hand therapy or an injection. ­― Dr. Sanjeev Kakar, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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