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Carpal Tunnel


Carpal tunnel syndrome involves the median nerve, one of the major nerve supplies to the lower arm and hand. The “tunnel” involved in carpal tunnel syndrome is formed at the wrist by the bones of the hand as the bottom and sides of the tunnel, with a thick, fibrous band of tissue called a ligament forming the top. The median nerve and nine of the tendons connecting the bones of the forearm to the bones of the hand run through this tunnel. Thick membranes that at times may swell cover the tendons. If they swell too much, the median nerve may be pressed up against the ligament forming the top of the tunnel, causing pain.

Signs and symptoms of carpal tunnel syndrome include numbness or tingling in the hand and decreased sensation in the thumb, index, and middle finger. Diagnosis may be aided by tapping on the wrist over the course of the median nerve, which should produce a strong tingling sensation in carpal tunnel syndrome. Holding the wrist bent at a downward angle for one minute should also reproduce symptoms. A study called a nerve conduction test may also be useful.

Treatment options depend on the severity of your case. For mild cases of carpal tunnel syndrome, immobilization of the affected wrist at night and medication with anti-inflammatory medications such as ibuprofen should help reduce the swelling and inflammation of the tendon membranes causing the pressure. For more severe cases, injection of cortisone (a strong anti-inflammatory) into the painful area may reduce the inflammation. If these treatments do not work, an out-patient surgery to cut the ligament forming the roof of the carpal tunnel, relieving pressure on the median nerve, may be necessary. Surgery may relieve symptoms immediately, or it may take some time for the nerve to heal before your symptoms disappear. Hand exercises provided by your physical therapist can improve your range of motion and strength in the affected wrist while healing from surgery.

Some risk factors for carpal tunnel syndrome include repetitive grasping or bending motions of the wrist and hands, rheumatoid arthritis, diabetes, arthritis, pregnancy, menopause, and thyroid hormone imbalances. Carpal tunnel syndrome is more common in women than in men, but occurs in both genders. For many people, it is related to repetitive motions on the job; however, in many cases a cause cannot be determined.

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