Carpal Tunnel Syndrome is a nerve compression syndrome caused by increased pressure to the median nerve at the wrist. Basically, the median nerve becomes pinched at the wrist.
There is a narrow space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand. Carpal Tunnel Syndrome happens when pressure in the tunnel builds up and compresses the nerve.
Carpal Tunnel Syndrome is the most common nerve compression in the upper extremity.
Causes of Carpal Tunnel Syndrome
The causes of Carpal Tunnel Syndrome are usually unknown. There are many different ways for pressure to increase in the carpal tunnel or there may be a combination of causes. Any one or more of the following factors can contribute to Carpal Tunnel Syndrome:
- Keeping the wrist bent for long periods of time.
- Joint dislocations, wrist fractures, swelling, and/or arthritis can narrow the tunnel.
- The lining of the flexor tendons may swell, which is known as tenosynovitis.
- Fluid retention during pregnancy can cause increased pressure in the tunnel. Symptoms usually go away after delivery.
- Thyroid conditions, rheumatoid arthritis, and diabetes.
- Tingling, "pins and needles", burning, and/or pain in the palms side of the thumb, index, middle and half of the ring fingers.
- Awakening at night due to numbness and/or pain
- Decreased sensation or numbness with certain activities such as driving or holding a newspaper
- Feeling clumsy or dropping things
- Pain radiating up the forearm into the hand
- Decreased strength and mobility
Anti-inflammatory medications can help to decrease pain, when inflammation is present.
Certified Hand Therapists can custom fit a splint for the affected wrist. The splint acts as a brace to support the joint and limit stress placed on it. Wearing a wrist splint at night can prevent the wrist from bending while sleeping.
Certified Hand Therapists can provide instruction in activity modification, alternative splinting options if over-the-counter splints are not comfortable, and a specific home exercise program.
A steroid injection into the carpal tunnel may help relieve symptoms by reducing swelling around the nerve.
If symptoms are severe or do not improve, despite non-operative treatment, surgery may be needed to make more room for the nerve and prevent permanent injury to the nerve. Your hand surgeon can help decide the best treatment for you.
TRIA Orthopaedic Center - Hand Surgery Walk Through
Courtesy of American Society for Surgery of the Hand
Figure 1: Where the median nerve and nine tendons pass from the forearm into the hand