Carpal tunnel syndrome is a condition that presents with numbness
and pain in the hands and wrists. This condition is caused by
compression of the median nerve at the wrist. This is a large
nerve that passes through a relatively tight tunnel in the region
of the wrist joint. The floor of this tunnel is comprised of the
wrist bones and the roof of the tunnel is a thick ligament
(transverse carpal ligament). Along with the median nerve, there
are nine tendons that also pass through this tunnel.
Any condition causes swelling of the tendons or increased pressure
in this tunnel can cause compression of the median nerve. Medical
conditions such as diabetes, rheumatoid arthritis, gout, thyroid
disease and pregnancy can cause carpal tunnel-like symptoms.
Repetitive motion of the fingers and hands can cause swelling
around the tendons which in turn can cause compression of the
median nerve.
Usual symptoms of carpal tunnel syndrome are numbness, pain, and
occasional burning of the fingers and hands. The thumb, index and
long fingers are the most often affected. These symptoms are worse
at night and frequently wake a patient. A patient will often shake
their hand to relieve the symptoms. Many patients complain of loss
of fine hand control or weakness of grip strength.
After diagnosis of carpal tunnel syndrome is made, conservative
treatment is initiated. This includes wearing a wrist splint,
possibly taking an oral anti-inflammatory medicine, and
occasionally a cortisone injection into the carpal tunnel.
Altering a patient’s work or recreational habits to avoid
repetitive motion and aggravating wrist position may also relieve
the patient’s symptoms.
If conservative measures fail to alleviate the symptoms, surgery
may become necessary. This surgical procedure involves opening the
roof of the carpal tunnel and alleviate pressure by dividing the
transverse carpal ligament. This procedure is usually performed
on an out-patient basis under local anesthesia. A splint is worn
for 1-3 weeks following surgery. Surgery reliably produces a
decrease in numbness or pain in the fingers and return of function
to the hand.
Early diagnosis and initiation of treatment can relieve the
symptoms of carpal tunnel syndrome and prevent the development of
permanent nerve or muscle damage.
