What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a condition that results in pain in the wrist that may radiate down to the hand, or up the forearm. Other symptoms include burning, tingling, itching or numbness of the hand and fingers. In advanced cases, decreased muscle strength and muscle wasting in the thumb area may occur. Carpal tunnel syndrome is the result of pressure on the median nerve, which controls sensation and movement in the thumb, index, middle and ring fingers. The median nerve passes through a bony canal in the wrist, called the carpal tunnel. Repetitive motion of the wrist can cause inflammation and swelling in the tendons that pass with the median nerve through the narrow carpal tunnel. The swollen structures press on the adjacent median nerve, resulting in localized and radiating pain.
Who is at Risk for Carpal Tunnel Syndrome?
Most cases of carpal tunnel syndrome occur in workers who spend a great deal of time working on a computer keyboard. Assembly line workers are also at risk. Athletes participating in sports involving repetitive wrist motion may be affected. The sports most often associated with repetitive motion injury are racquetball, tennis, golf, and bowling.
How is Carpal Tunnel Syndrome Diagnosed?
- Physical Exam – The wrist is tested for point tenderness, and range of motion. The hand is examined for signs of muscle wasting. The fingers are tested for signs of reduced sensation.
- Tinel Test – The physician taps the underside of the wrist, in the area of the median nerve. A positive test elicits feelings of tingling, and/or a shock-like sensation in the hand and fingers.
- Wrist Flexion Test – The palms are pressed together, flexing the wrists as much as possible. A positive test results in worsening of the patient’s symptoms within one minute of flexing the wrist.
- Electromyography (EMG) and Nerve Conduction Velocity Test – These exams measure muscle function and speed of nerve impulse transmission, in the affected area.
- Magnetic Resonance Imaging (MRI) – Although MRI does not show carpal tunnel syndrome changes, it is helpful to rule out other wrist abnormalities that may mimic carpal tunnel syndrome.
How is Carpal Tunnel Syndrome Treated?
- Medications – Oral anti-inflammatory drugs, such as ibuprofen may be prescribed. Oral or injected corticosteroids may be used in more severe cases.
- Exercise – Stretching and strengthening exercises, usually under supervision of a physical therapist, may be prescribed, especially after symptoms improve.
- Surgery – In intractable cases surgery is used. A “release” procedure, where the carpal ligament is cut to enlarge the carpal tunnel and relieve pressure on the median nerve, can be performed either endoscopically, or using “open” technique.
For more information, refer to MedicineNet.com
Steven M. Cohen - Dr. Steven Cohen is a practicing physician, specializing in Diagnostic Radiology. Dr. Cohen, a member of the American College of Sports ...
