Carpal tunnel syndrome is a common disorder affecting the hand. Unlike sprains and tendonitis, which involve injury or inflammation of ligaments or tendons, carpal tunnel syndrome is caused by nerve compression at the wrist.

The carpal tunnel is a small anatomical passageway created by the arch-like arrangement of the small bones that make up your wrist. A tough ligament called the transverse carpal ligament forms the roof of this tunnel. Nine flexor tendons within their protective sheaths and the median nerve all pass through this small, inflexible boney space. The median nerve is a major nerve to the hand that provides sensation to the thumb, index, long and the ring fingers, and muscle function to the thumb.

Symptoms:

  • The symptoms include pain, numbness and/or tingling especially in the thumb, index, long and ring fingers. First signs often include waking with pain radiating into the hand from the wrist and/or numbness and tingling in these fingers. This can initially be resolved by shaking or moving the hand around. Symptoms can progress, causing numbness/tingling that is more constant; dropping things, and hand weakness.

Diagnosis:

  • Your doctor will take a detailed history including medical background, type of work or hand use, and description of your symptoms. An x-ray can reveal fractures or arthritis. Nerve conduction and electromyogram tests (NCV, EMG) can confirm the diagnosis of carpal tunnel syndrome but can also detect nerve function problems at the elbow or neck, which can cause the same symptoms.

Treatment:

  • Carpal tunnel symptoms can resolve without surgery. Night splinting with the wrist in a neutral position, anti-inflammatory medications and altering your hand use patterns can bring relief. This often takes several weeks/months.

If symptoms do not improve, are long standing, or worsening, surgery is done to relieve the pressure on the median nerve by cutting the ligament that forms the roof of the tunnel. After the surgery, there could be some soreness, swelling or hypersensitivity around the incision that lasts weeks or months. Sensation may improve rapidly, may resolve slowly, or may not resolve completely especially in severe or long standing cases. Hand strength will return slowly over the next weeks and months.

Therapy:

  • A hand therapist may custom-make your night splints, and teach you how to avoid provoking and worsening your symptoms by the way you use your hands. In some cases, sensory function and strength can be evaluated to measure the extent of numbness and weakness. After surgery, therapy can help to manage scarring and hypersensitivity, and to regain motion and strength if stiffness and weakness are present. Your therapist can help you to return to your everyday activities while addressing your post-operative concerns.
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