Southern Illinois Hand Center

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Description

Carpal tunnel syndrome is a condition characterized by numbness and tingling and pain of the hand as a result of compression of one of the nerves (the median nerve) as it passes through the wrist. Anatomy: The median nerve, as it travels from the forearm to the hand, passes through the wrist in a narrow, rigid tunnel, which is called the carpal tunnel. The tunnel is made up of the wrist bones, which are arranged in the form of a “C ”. On the palm side there is a very strong ligament that connects these bones together and create a tunnel between that ligament and the bones. Through that tunnel, the median nerve passes with other flexor tendons, which are 9 (two for each finger and one for the thumb). The tendons are surrounded by a flimsy, spongy tissue called the tenosynovium. How is it produced? Anything that increases the volume of the structures passing through the carpal tunnel, will cause pressure against the median nerve. A non-specific inflammatory swelling of the tenosynovium (tendon linings) can cause an increase in the pressure inside the carpal tunnel, causing pressure against the nerve. Several causes have been linked to the development of carpal tunnel syndrome, such as tasks that require rapid repetitive use of the hands, the use of vibrating tools, or prolonged power grip. Bone dislocations, fractures and arthritis can also cause narrowing of the tunnel, but they are usually not as common. Other conditions such as hypothyroidism, rheumatoid arthritis and diabetes can increase the likelihood of developing carpal tunnel syndrome. Fluid retention during pregnancy can sometimes cause swelling in the tunnel and produce symptoms of carpal tunnel syndrome, which are usually reversible after the pregnancy is over. Symptoms: 1. Numbness and tingling, usually in the distribution of the median nerve involving the thumb, index and long fingers. However, sometimes it may involve one digit or sometimes it involves all the digits. 2. Pain in the form of aching pain in the wrist or forearm that may radiate to the elbow and sometimes to the shoulder. 3. Weakness and clumsiness. 4. The symptoms may increase with driving or with elevation of the hand, such as using a hair dryer. 5. In severe or advanced cases, the sensation may be markedly decreased or even lost. Patients also may develop severe weakness of the use of the thumb with wasting of the thumb muscles. Diagnosis: An accurate medical history and detailed clinical examination will establish the diagnosis in most cases. A nerve test, called a nerve conduction study and electromyography (EMG) is often obtained to confirm the diagnosis. Other tests may be needed, depending on the patient ’s symptoms. Prevention: The risk of developing carpal tunnel syndrome may be reduced by modifying the way you use your hands. Keep these suggestions in mind during daily activities. 1. Keep your wrists in neutral. Avoid keeping the wrist in a bent or twisted position for a long period of time. Instead, try to maintain a straight position. 2. Watch your grip. Increased stress is put on the wrist when you grip, grasp or lift with your index finger and thumb.

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