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Carpal Tunnel Syndrome

Basic Overview

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Updated November 28, 2007

Carpal tunnel syndrome occurs when the median nerve is compressed at the wrist. The median nerve originates from cervical spinal nerves and controls movement and sensation to the palmer side of the hand, thumb, and fingers. The carpal tunnel, a narrow passageway in the wrist, is formed by bones on the bottom and sides and a ligament which composes the top of the tunnel. The tunnel also contains nine tendons that are connected to the bones and muscles of the hand. Under various circumstances these tendons may swell and enlarge causing compression of the median nerve against the ligamentous roof which results in the symptoms experienced in carpal tunnel syndrome.

Numbness and a “pins and needle” sensation are the most common symptoms experienced in carpal tunnel syndrome. Most often the thumb, index, and middle fingers are involved. Symptoms are often worse upon wakening or during activities that involve flexion and extension of the wrist. As the syndrome worsens, decreased grip strength makes it difficult to perform tasks with the involved hand.

Management of carpal tunnel syndrome includes a broad spectrum of options from non-invasive techniques to surgical management. In general all patients with carpal tunnel syndrome should avoid repetitive motions of the wrist and hand. Ergonomic measures to relieve symptoms at work should be taken. For example, those who utilize computers daily can significantly decrease symptoms by maintaining proper wrist positioning while typing. Applying a splint to immobilize the wrist in a neutral position is another effective non invasive treatment for carpal tunnel syndrome. For those requiring additional treatment oral medicines such as nonsteroidal anti-inflammatory drugs, diuretics, and corticosteroids are available. These drugs work to ease the pain and swelling associated with carpal tunnel syndrome. Additionally a local injection of corticosteroids can be performed which will relieve the pressure on the median nerve and provide temporary relief. In patients whose symptoms are not relieved by the above measures, it may be necessary to perform surgery. The surgical procedure involves cutting the ligament that forms the roof of the carpal tunnel thus relieving the pressure on the median nerve.

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