Carpal Tunnel Syndrome

The carpal tunnel is an area at the wrist where tendons and other structures of the hand pass from the forearm to the hand. Within the carpal tunnel is the median nerve that is a nerve that control sensation palm side of the thumb, index finger, and long fingers. Carpal tunnel syndrome is a source of numbness or pain in these fingers.

Carpal tunnel syndrome may occur when tissues/tendons within the carpal tunnel swell resulting on pressure on the median nerve. This often does not have a definitive cause. Risk factors include heredity, hormonal changes, older age, and medical conditions such as diabetes, rheumatoid arthritis, and thyroid gland imbalance.

Typical symptoms include hand numbness, tingling, and pain while sleeping at night or while holding objects, difficult with fine movements, and even wasting of the muscles around the thumb.

Initial evaluation includes a medical history and physical examination. X-rays are often not needed. Specialized examination manuvers may be used to determine the extent of compression. Nerve conduction studies may be done to confirm the diagnosis and determine the best treatment option.

Initial treatment is typically nonsurgical. Often pain can be relieved with bracing, anti-inflammatory medications, and activity modifications. A night brace or splint worn keeping the wrist in a neutral position may decrease symptoms. Corticosteroid injection will often provide temporary relief.

For those with continued pain despite nonsurgical treatment outpatient carpal tunnel release may be considered. Use of the hand is allowed a few days after surgery and sensation recovery is gradual. Typically grip and pinch strength return by about 2 months after surgery.