Carpal tunnel syndrome is a set of sensory and sometimes motor disorders caused by compression of the median nerve at the wrist in the carpal tunnel. Its symptoms are pain, tingling, numbness in the sensory area of the median nerve: thumb, index finger, middle finger and the side of the ring finger facing the middle finger. In some patients, these symptoms extend to the entire hand or sometimes spread to the forearm and even the shoulder.

Carpal tunnel syndrome is common in adults, more so in pregnant or postmenopausal women, obese patients and those with diabetes, hypothyroidism, or amylosis. Trauma to the hand and wrist area, such as a broken wrist, repetitive, forceful movements, or hand and wrist vibrations, can lead to carpal tunnel syndrome. Median nerve neuropathy, connective tissue disease or joint disorders such as osteoarthritis or rheumatoid arthritis can also be a cause.

Carpal tunnel syndrome is sometimes medication-related. The drugs now known to expose patients to carpal tunnel syndrome chiefly include: aromatase inhibiting antiestrogens such as anastrozole, exemestane and letrozole, used to treat some breast cancers; disphosphonates used in osteoporosis; oral anticoagulants; and some antiretrovirals.

When a drug is likely to be the cause of carpal tunnel syndrome, discontinuation should be considered, since this often allows symptoms to regress and sometimes avoids the need for surgery.

©Prescrire 1 September 2019

"Carpal tunnel syndrome: sometimes drug-induced" Prescrire Int 2019; 28 (207): 209-211. (Pdf, subscribers only).

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