Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition brought on by increased pressure or a
pinched nerve at the wrist. Symptoms may include numbness, tingling, and pain
in the arm, hand, and fingers. 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 (see Diagram 2). Carpal tunnel syndrome happens when pressure builds up
from swelling in this tunnel and puts pressure on the nerve. When the pressure
from the swelling becomes great enough to disturb the way the nerve works, numbness,
tingling, and pain may be felt in the hand and fingers (see Diagram 1).
Causes of carpal tunnel syndrome
Usually the cause is unknown. Pressure on the nerve can happen several ways:
swelling of the lining of the flexor tendons, called tenosynovitis; joint dislocations,
fractures, and arthritis can narrow the tunnel; and keeping the wrist bent for
long periods of time. Fluid retention during pregnancy can cause swelling in
the tunnel and symptoms of carpal tunnel syndrome, which often go away after
delivery. Thyroid conditions, rheumatoid arthritis, and diabetes also can be
associated with carpal tunnel syndrome. There may be a combination of causes.
Signs and symptoms of carpal tunnel syndrome
Carpal tunnel syndrome symptoms usually are pain, numbness, tingling, or a
combination of the three. 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 also may be noticed during daily activities such as driving or
reading a newspaper. Patients sometimes notice they have a weaker grip, occasional
clumsiness, and may drop things. In severe cases, sensation may be permanently
lost and the muscles at the base of the thumb slowly shrink (thenar atrophy).
How hand surgeons diagnose carpal tunnel syndrome
A detailed history including medical conditions, how the hands have been used,
and whether there were any prior injuries is important. An X-ray may be taken
to check for other causes of the complaints such as arthritis or a fracture.
In some cases, laboratory tests may be done if there is a suspected medical
condition that is associated with CTS. An NCV or nerve conduction study and
EMG or electromyogram may be done to check for other sites of nerve problems
as well as to evaluate the carpal tunnel.
Non-surgical treatment for carpal tunnel syndrome
Symptoms can often be relieved without surgery. Identifying and treating medical
conditions, changing the patterns of hand use, or keeping the wrist splinted
in a straight position may help reduce pressure on the nerve. Wearing wrist
splints at night may relieve the symptoms that interfere with sleep. Anti-inflammatory
medication taken by mouth or injected into the carpal tunnel may help relieve
the carpal tunnel symptoms.
Why surgery is sometimes necessary for carpal tunnel syndrome
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
which forms the roof (top) of the tunnel on the palm side of the hand (see Diagram
3). Incisions for this surgery may vary, but the goal is the same — to
enlarge the tunnel and decrease pressure on the nerve. Following surgery, soreness
around the incision may last for several weeks or months. The numbness and tingling
may disappear quickly or slowly. It may take several months for strength in
the hand and wrist to return to normal. Carpal tunnel symptoms may not completely
go away after surgery, especially in severe cases.
Diagram 1
Aspects of median nerve function.
Diagram 2
The carpal tunnel is found at the base of the palm. It is formed by the bones
of the wrist and the transverse carpal ligament. Increased pressure in the tunnel
affects the function of the median nerve.
Diagram 3
The goal of surgery is to free the ligament to allow more room for the median
nerve in the carpal tunnel.
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