Carpal Tunnel Syndrome
The carpal tunnel is a small passage way created by the small bones, carpal bones, in your wrist and a ligament called the transverse carpal ligament (Figure 1). This tunnel provides a pathway for the main nerve which extends to the hand, the median nerve, and the nine flexor tendons which enable you to bend your fingers. This nerve is responsible for allowing you to feel sensation in each of your fingers, as well as it controls the muscles near the base of the thumb. Being that the carpal tunnel is relatively rigid, any inflammation or damage to this area can put stress on the median nerve or tendons responsible for finger movement.
Carpal tunnel syndrome occurs when this tunnel narrows, due to swelling of the flexor tendons or transverse carpal ligament, and puts unnecessary pressure on the median nerve; Figure 2 (Visual Health Solutions, 2016). Synovium fluid, which lubricates the tendons in the hand and wrist, can also swell and crowd the nerve. Over time the added pressure on the nerve can cause pain, numbness, tingling and eventually weakness in the hand.
It has been found that women and those who are older are more susceptible to developing carpal tunnel syndrome (Atroshi, 1999). In addition to this there is an assortment of other factors responsible for causing carpal tunnel syndrome (AAOS, 2016).
- Repetitive hand use.
- Prolonged hand or wrist flexion or extension.
- Other health conditions.
- oDiabetes (Atroshi, 1999)
- oThyroid disorders
Symptoms can include (AAOS, 2016):
- Numbness, tingling or pain in the thumb and index fingers, spreading to the other fingers.
- oMay feel a shocking sensation periodically to the fingers.
- Pain or tingling that travels up the forearm to the shoulder.
- Weakness or awkwardness in the use of the hand.
- oCan cause one to drop items more often
- oLack of awareness of the positioning of the hand
- oFine motor movements, such as tying of shoes or buttoning of shirts, become more difficult
Carpal tunnel syndrome usually develops over time and without any specific event to the wrist and the symptoms may even come and go. Eventually, the symptoms become persistent and prolong the time in which they present themselves. Wrist movement often temporarily relieves the symptoms, as it temporarily repositions the median nerve or surrounding tendons. A doctor is the only one who can officially diagnose carpal tunnel syndrome, but there are simple tests you can do at home prior to seeing a doctor. By pressing along the median nerve on the inside of your wrist, it is possible to test for numbness or tingling in the fingers. Also, with your eyes closed, lightly apply pressure or an item to your fingertips to detect any irregularities in sensation (Levine, 1993). These and other quick tests may help you be able to guide a thorough discussion with your doctor.
Without treatment carpal tunnel syndrome will worsen with time and can cause irreversible damage. The earlier you begin treatment, the more likely the disease progression can be stopped or hindered. Prolonged symptoms may require surgical treatment and lengthy recovery and therapy to regain strength to the hand and fingers (Burton, 2016).
- Braces or splints can keep you from bending your wrist at night, which may pinch the nerve and cause discomfort. Keeping the wrist in a neutral position will relieve the pressure on the median nerve. It is also helpful to wear a splint during the day while performing activities that might otherwise aggravate your symptoms.
- Pain relieving and anti-inflammatory medications to reduce swelling.
- Nerve gliding exercises
- Steroid injections.
These are recommendations for the management of carpal tunnel syndrome only and may not apply to each and every individual case and may rely on expert opinions. This information is provided as an educational service and is not intended to serve as medical advice. It is important to seek advice from a physician if chronic pain occurs and before starting any medical treatments.
- 1.AAOS. (2016). Carpal tunnel sydrome. http://orthoinfo.aaos.org/topic.cfm?topic=a00005.
- 2.Atroshi, I., Gummesson, C., et al. (1999). Prevalence of carpal tunnel syndrome in a general population. Journal of the American Medical Association. 281(2). 153-158.
- 3.Burton, C.L., et. al. (2016). Clinical course and prognostic factors in conservatively managed carpal tunnel syndrome: A systematic review. Archives of Physical Medicine and Rehabilitation. 97(5). 836-852.
- 4.Levine, D.W., Simmons, B.P., et. al. (1993). A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. The Journal of Bone and Joint Surgery. 75 (11). 1585-1592.