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.