Carpal Tunnel Syndrome | orthohandsurgery

Carpal tunnel syndrome is essentially a pinched nerve in the wrist.
There is a space in the wrist called the carpal tunnel where the
median nerve and nine tendons pass from the forearm into the hand
(Figure 1). Carpal tunnel syndrome happens when pressure builds up
from swelling in this tunnel and puts pressure on the nerve.

Causes
Pressure on the nerve can happen several ways, including:
• Swelling of the lining of the flexor tendons, called tenosynovitis
• Joint dislocations
• Fractures
• Arthritis
• Fluid retention during pregnancy
The situations listed above can narrow the carpal tunnel or cause
swelling in the tunnel. Thyroid conditions, rheumatoid arthritis and
diabetes can also be associated with carpal tunnel syndrome.
Ultimately, there can be many causes of this condition.
Signs and Symptoms
Symptoms of this condition can include:
• Pain
• Numbness
• Tingling
• Weak grip
• Occasional clumsiness
• Tendency to drop things
The numbness or tingling most often takes place in the thumb, index,
middle and ring fingers. The symptoms usually are felt during the
night but may also be noticed during daily activities such as driving or
reading a newspaper. In severe cases, sensation and strength may be
permanently lost.
Diagnosis
A detailed history including medical conditions, how the hands
have been used, and any prior injuries is important in diagnosing
carpal tunnel syndrome. An x-ray may be taken to check for
arthritis or a fracture. In some cases, laboratory tests may be done.
Electrodiagnostic studies are also a possibility to confirm the diagnosis
and check for other possible nerve problems.
Treatment
Symptoms may often be relieved without surgery. Some treatment
options are:
• Changing patterns of hand use (helps reduce pressure on the nerve)
• Keeping the wrist splinted in a straight position (helps reduce
pressure on the nerve)
• Wearing wrist splints at night (helps relieve symptoms that interfere
with sleep)
• Steroid injections into the carpal tunnel (helps reduce swelling
around the nerve)
When symptoms are severe or do not improve, surgery may be needed to
make more room for the nerve. Pressure on the nerve is decreased by
cutting the ligament that forms the top of the tunnel on the palm side
of the hand (Figure 2). Following surgery, soreness around the cut
area may last for several weeks or months. The numbness and tingling
may disappear quickly or slowly. Recovery may take several months.
Carpal tunnel symptoms may not completely go away after surgery,
especially in severe cases.
Carpal Tunnel Syndrome
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