Conditions

Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a progressively painful hand and arm condition caused by a pinched nerve in the wrist. It occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed. In general, anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome, including wrist anatomy, underlying health problems and patterns of hand use.

Figure 1: 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.

Risk factors include:

  • A wrist fracture or dislocation
  • Nerve-damaging conditions such as diabetes or alcoholism
  • Inflammatory conditions such as rheumatoid arthritis
  • Repetitive hand or wrist movements

Women are three times more likely than men to develop carpal tunnel syndrome.

What are the symptoms of carpal tunnel syndrome?

Symptoms usually start gradually with a vague aching in your wrist that can extend to your hand or forearm. Additional symptoms may include:

Figure 2:Aspects of median nerve function.
  • Tingling or numbness in your fingers or hand, especially your thumb and index, middle or ring fingers
  • Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers
  • Weakness in your hands and a tendency to drop objects

The dominant hand is usually affected first and produces the most noticeable symptoms.

How is carpal tunnel syndrome diagnosed?

In addition to a health history, your doctor should perform a physical exam of your neck and the entire extremity. Your doctor may also recommend nerve testing to see if the median nerve is working as it should.

What is the treatment?

Mild symptoms usually can be treated with home care. Take frequent breaks to rest your hands and apply cold packs to reduce occasional swelling. Additional treatment options include wrist splinting (especially at night), non-steroidal anti-inflammatory drugs and injectable corticosteroids.

If these non-operative treatments don't work, and your symptoms persist or worsen, surgery may be a good option. The goal of carpal tunnel release surgery is to relieve pressure on your median nerve by cutting the ligament at the top of the carpal tunnel pressing on the nerve. Surgery is performed under general or local anesthesia and does not require an overnight hospital stay. During the healing process, the ligament tissues gradually grow back together, allowing more room for the nerve.

After surgery, there are no restrictions on activities. However, heavy gripping and lifting may cause pain for several days or weeks. As with all surgical procedures, specific recovery time varies by patient and demand.

Figure 3: The goal of surgery is to free the ligament to allow more room for the median nerve in the carpal tunnel.

© 2009 American Society for Surgery of the Hand
Developed by the ASSH Public Education Committee

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