CARPAL TUNNEL SYNDROME

CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. A narrow, rigid passageway of ligament and bones at the base of the hand—houses the median nerve and the tendons that bend the fingers. The median nerve provides feeling to the palm side of the thumb and to the index, middle, and part of the ring fingers (although not the little finger). It also controls some small muscles at the base of the thumb.

Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and compresses the median nerve. The result may be numbness, weakness, or sometimes pain in the hand and wrist (some people may feel pain in the forearm and arm). CTS is the most common and widely known of the entrapment neuropathies, in which one of the body’s peripheral nerves is pressed on or squeezed.

HAND & WRIST ANATOMY

DISEASE EXPLAINED

SYMPTOMS

Tingling or numbness. You may notice tingling and numbness in your fingers or hand. Usually the thumb and index, middle or ring fingers are affected, but not your little finger. You might feel a sensation like an electric shock in these fingers.

The sensation may travel from your wrist up your arm. These symptoms often occur while holding a steering wheel, phone or newspaper, or may wake you from sleep.

Many people "shake out" their hands to try to relieve their symptoms. The numb feeling may become constant over time.

Weakness. You may experience weakness in your hand and drop objects. This may be due to the numbness in your hand or weakness of the thumb's pinching muscles, which are also controlled by the median nerve.

CAUSES

Carpal tunnel syndrome is caused by pressure on the median nerve.

The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).

Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation caused by rheumatoid arthritis.

Many times, there is no single cause of carpal tunnel syndrome. It may be that a combination of risk factors contributes to the development of the condition.

TREATMENT

TREATMENT OPTIONS

Wrist splinting
A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Even though you only wear the splint at night, it can also help prevent daytime symptoms. Nighttime splinting may be a good option if you're pregnant because it does not involve the use of any medications to be effective.

Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.

Corticosteroids
Injection into your carpal tunnel with a corticosteroid such as Kenalog or Betamethasone to relieve pain. Sometimes using an ultrasound will help guide these injections.
Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren't considered as effective as corticosteroid injections for treating carpal tunnel syndrome.

Endoscopic surgery
We use a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel. The surgeon cuts the ligament through one or two small incisions in your hand or wrist. Sometimes, the surgeon may use ultrasound instead of a telescope to guide the tool that cuts the ligament.
Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.

Open surgery
The surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.

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