Carpal Tunnel

Most people have heard of carpal tunnel syndrome (CTS) because it is a relatively common condition. It refers to the complex group of symptoms and signs brought on by the compression of the median nerve as it travels through the carpal tunnel. When this nerve is compressed it can cause pain and altered sensation in the hand and sometimes weakness in the median nerve distribution. The median nerve controls the movement and feeling of your thumb and some movements of all the fingers with exception of the pinky.

Symptoms of carpal tunnel syndrome may include, occasional shock-like sensations to the thumb, index middle and ring fingers. The patient may experience pain or tingling that may travel up the forearm toward the shoulder. Weakness and clumsiness in the hand that may make it difficult to perform fine movements such as buttoning your clothes. CTS usually begins gradually without specific injury. As the condition worsens, symptoms will occur more frequently and persist for longer periods of time. Night-time symptoms are very common, because many people sleep with their wrists bent and the symptoms may awaken you from sleep. Symptoms may also become more pronounced during the day when performing activities that cause the patient to have their wrist positioned in prolonged extension or flexion.

Many times, the cause for CTS is unknown, although some medical conditions increase the risk factor such as diabetes, pregnancy, rheumatoid arthritis, hypothyroidism, connective tissue disease, and preexisting median mononeuropathy. Obesity and female gender as well as genetic predisposition can be contributing factors to CTS. Repeating the same hand and wrist motions or activities over a prolonged period may aggravate the tendons of the wrist, causing swelling that puts pressure on the nerve contributing to CTS. Doing activities that involve extreme flexion or extension of hand and wrist for a prolonged period can increase pressure on the nerve and worsen symptoms

Carpal tunnel syndrome is suspected based on the symptoms and distribution of the hand numbness. Your doctor will exam your had and wrist and may perform several physical tests including, taping down on your median nerve to see if it causes any numbness of tingling in your fingers. The doctor may bend your wrists in a flexed position to test for numbness or tingling in your hands and test the sensitivity in your fingertips and check for muscle wasting and weakness. Additional tests such as nerve conduction studies to measure the signal traveling in the nerve of your hand and electromyogram that measures the electrical activity in muscles may be performed. These tests would show slowing of the electrical signal in the nerve and muscle when CTS is present.

Treatment may be conservative and nonsurgical if the condition is caught early. Bracing or splinting the wrist in a neutral position reduces the pressure on the nerve in the carpal tunnel. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and inflammation. Changing and modifying recreational and job activities that aggravate your symptoms may help with the symptoms. If these activities do not relieve your symptoms surgery may be recommended. This surgery is called a carpal tunnel release and usually is done on an outpatient basis. In this surgery the doctor cuts the ligament around the carpal tunnel to take pressure of the median nerve and relieve your symptoms. If you have a severe case of CTS, surgery can help, but your symptoms may not go away completely. For more information go to www.medicinenet.com/carpal_tunnel_syndrome.