What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a condition that affects the main nerve in the wrist area. Located between the wrist bones, the carpal tunnel is a space that is naturally formed by the arch of the wrist. Located at the top of the tunnel is a thick band known as the transverse carpal ligament. As a result, the bones and ligaments act like solid walls, preventing the tunnel from changing size. Passing through the tunnel are nine tendons that bend the fingers and thumb, along with the median nerve. The median nerve is responsible for providing sensation to the skin of the thumb, index and middle fingers, as well as half of the ring finger. This nerve also communicates with the muscles at the base of the thumb.
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome is caused by excess pressure on the median nerve at the wrist. Swelling (inflammation) of the contents inside the tunnel can cause extra pressure. The term compressive neuropathy refers to nerve symptoms caused by pressure. Although the exact causes of carpal tunnel syndrome are unknown, there are a number of factors that can contribute to increased pressure or inflammation. Some include:
Rheumatoid arthritis, gout, infections, psoriatic arthritis, arthritic spurs of the carpal bones, a wrist fracture or dislocation of the wrist, and repetitive motions performed at work or home.
Symptoms of Carpal Tunnel Syndrome
Although the symptoms of carpal tunnel tend to be worse at night, sleep does not cause the condition. Driving a car can cause some people to experience symptoms. Additionally, this is not necessarily the primary cause of the problem. It is possible that the wrist position during driving or sleep aggravates symptoms.
Most people with carpal tunnel syndrome experience numbness and/or tingling in their thumb, index and middle fingers, and all or half of their ring finger (the finger closest to the thumb). A numbness or tingling sensation usually starts gradually with carpal tunnel syndrome. It is possible for mild symptoms to come and go for months or even years without worsening. Daytime and nighttime symptoms may occur.
Some of the time the symptoms of carpal tunnel tend to be worse at night, sleep does not cause the condition. Driving a car can cause some people to experience symptoms. Additionally, this is not necessarily the primary cause of the problem. It is possible that the wrist position during driving or sleep aggravates symptoms.
Treatment for Carpal Tunnel Syndrome
Many patients with carpal tunnel syndrome are diagnosed based on their symptoms and a physical examination. In order to determine which fingers are affected by numbness or tingling, it is important to know which ones are not. During the physical examination, your hand surgeon will test the sensation in the fingers and hand on the palm and back sides. Sensory testing may also be performed on the forearm and arm if there is numbness outside the median nerve area. Other tests that the doctor may perform include the Phalen's maneuver, the Tinel's test, and a compression test. By increasing pressure on the median nerve, these tests cause your symptoms to appear. EMG (electrodiagnostic studies) may also be used to diagnose the condition. Using these tests, you can determine whether the nerves are functioning properly.
Treatment aims to reduce or remove the causes of increased nerve pressure. Symptoms should decrease as a result.
Non-surgical treatment options include:
Inflammatory medicine
Steroid injection (cortisone shot)
Wrist splint(s)
Surgical Treatment
One of the most effective treatments is the surgical release of the carpal tunnel ligament. It takes the extra pressure off the nerve immediately and reliably. There are several surgical techniques to cut the transverse carpal ligament. By opening the ligament, there is more room for the tendons and the nerves to pass through the tunnel.
