Advancing Neuromuscular, Musculoskeletal, & Electrodiagnostic Medicine

Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

The carpal tunnel is a small tunnel made of bones and ligaments in the wrist. The median nerve runs down the forearm through the tunnel and into the hand on the palm side of the hand and provides feeling to the hand and fingers. The median nerve can become compromised from inflammation under this tunnel, which leads to carpal tunnel syndrome. The carpal tunnel does not allow for movement or growth of the nerve. Therefore, when it inflames, the median nerve is constricted and does not allow blood to flow through the hand to the fingers.


What causes Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) can be a result of many different things. It can be due to work, lifestyle, health, injuries, and even genetic predisposition. The most common cause of CTS is repetitive motion. Certain conditions like diabetes, pregnancy, and obesity can predispose somebody to CTS. Common symptoms include numbness and pain in the hand. This is typically worse at night and can awaken one from sleep. It is typically relieved by shaking the hand. Other symptoms can be the tendency to drop things, difficulty manipulating small objects, and a burning sensation. With progression of the carpal tunnel syndrome there can be decreased sensation in the hand, muscle atrophy in the palm, and decreased hand strength and function.


How is Carpal Tunnel Syndrome diagnosed?

CTS can be diagnosed in a variety of ways. Physical examinations can show evidence of CTS. A Tinel's test might be used by your physician. The physician will gently tap on the front of the wrist, which may cause tingling or pain in the hand. A Phalen's test can also be used. The physician will bend your wrist fully forward and then hold it in that position for a period of time. This may produce tingling or numbness in the fingers. Physicians use nerve conduction studies (NCSs) and needle EMG to diagnose CTS. Nerve conduction studies measure electrical impulse speeds traveling through the nerve. An electrical stimulation will be sent down the nerve from various points in your upper arm and forearm. The time it takes for that electrical message to reach a point in the hand is then carefully measured by the physician. The physician will determine whether the nerves in the upper arm and forearm are carrying the message normally and whether if he message gets to the wrist and is slowed down or reduced in intensity. If a person has CTS, the speed of the impulse will decrease as it passes through the carpal tunnel. An EMG can also help diagnose CTS. Blood tests may be performed to rule out other conditions.


How is Carpal Tunnel Syndrome treated?

There can be several ways to treat CTS. Treatment can include stretching exercises, immobilizing the wrist, anti-inflammatory drugs, vitamin B6, cortisone injections, ice, modifying activities, and the extreme, surgery. Surgery for CTS is successful 95% of the time. The best way to avoid recurrence is to modify the behaviors that caused the CTS.


More information on Carpal Tunnel Syndrome

American Chronic Pain Association
MedicineNet.com
National Institute of Neurological Disorders and Stroke
E-Hand.com