COULD IT BE CARPAL TUNNEL SYNDROME?
By Tze C. Ip, MD
Carpal tunnel syndrome refers to an inflammation of the median nerve at
the wrist. There is a structure in the wrist called the carpal tunnel,
through which the median nerve and nine tendons pass from the forearm
into the hand. Carpal tunnel syndrome results when swelling in this tunnel
puts pressure on the nerve. Over time the increased pressure affects the
way the nerve works, resulting in tingling, numbness and pain in the hand
and fingers. Simply put, carpal tunnel syndrome can be likened to a pinched
nerve at the wrist.
Although it has often been characterized as a repetitive-motion injury,
there is no evidence to support this view. More likely, carpal tunnel
syndrome is attributable to one of several conditions. These may include
a swelling of the lining of the flexor tendons, called tenosynovitis.
Joint dislocations, fractures, and arthritis can narrow the tunnel, putting
pressure on the nerve. Keeping the wrist bent for long periods of time,
which may arise due to improper keyboard technique, can also exacerbate
the condition. Even thyroid conditions, rheumatoid arthritis, and diabetes
can be associated with carpal tunnel syndrome. There may also be a combination
of causes contributing to the condition.
The numbness or tingling associated with carpal tunnel syndrome usually
occurs in the thumb, index, middle, and ring fingers. It may arise during
daily activities such as driving or reading a newspaper, and some patients
may notice a weaker grip, occasional clumsiness, and a tendency to drop things.
Conservative management of carpal tunnel syndrome is usually the treatment
of choice when symptoms are not severe. This may include anti-inflammatory
medications to reduce swelling and wearing a brace overnight. More serious
cases of carpal tunnel syndrome may warrant cortisone injections. In chronic
cases where conservative management has failed to provide relief, surgery
may be necessary to release the tendon. Fortunately, this is an outpatient
procedure and patients usually have the use of their hands and fingers
immediately after surgery.
For more information on carpal tunnel syndrome, be sure to check out the
interactive video on Patient Education section of our web-site.