Carpal tunnel syndrome is a condition that presents with numbness and pain in the hands and wrists. This condition is caused by compression of the median nerve at the wrist. This is a large nerve that passes through a relatively tight tunnel in the region of the wrist joint. The floor of this tunnel is comprised of the wrist bones and the roof of the tunnel is a thick ligament (transverse carpal ligament). Along with the median nerve, there are nine tendons that also pass through this tunnel.
Any condition causes swelling of the tendons or increased pressure in this tunnel can cause compression of the median nerve. Medical conditions such as diabetes, rheumatoid arthritis, gout, thyroid disease and pregnancy can cause carpal tunnel-like symptoms. Repetitive motion of the fingers and hands can cause swelling around the tendons which in turn can cause compression of the median nerve.
Usual symptoms of carpal tunnel syndrome are numbness, pain, and occasional burning of the fingers and hands. The thumb, index and long fingers are the most often affected. These symptoms are worse at night and frequently wake a patient. A patient will often shake their hand to relieve the symptoms. Many patients complain of loss of fine hand control or weakness of grip strength.
After diagnosis of carpal tunnel syndrome is made, conservative treatment is initiated. This includes wearing a wrist splint, possibly taking an oral anti-inflammatory medicine, and occasionally a cortisone injection into the carpal tunnel. Altering a patient’s work or recreational habits to avoid repetitive motion and aggravating wrist position may also relieve the patient’s symptoms.
If conservative measures fail to alleviate the symptoms, surgery may become necessary. This surgical procedure involves opening the roof of the carpal tunnel and alleviate pressure by dividing the transverse carpal ligament. This procedure is usually performed on an out-patient basis under local anesthesia. A splint is worn for 1-3 weeks following surgery. Surgery reliably produces a decrease in numbness or pain in the fingers and return of function to the hand.
Early diagnosis and initiation of treatment can relieve the symptoms of carpal tunnel syndrome and prevent the development of permanent nerve or muscle damage.