Carpal Tunnel Syndrome

To prevent carpal tunnel syndrome, try to maintain proper posture at the computer. If possible, have your workstation ergonomically designed.

Carpal tunnel condition, caused by compression of the median nerve at the wrist, results in numbness, tingling, weakness and discomfort in the wrist and hand. The floor and walls of the carpal tunnel are formed by a group of wrist bones (carpals), while the roof is a strong ligament on the inside of your wrist called the transverse carpal ligament. This ligament forms a bridge over the group of bones, creating a tunnel at the junction of the hand and wrist. The median nerve and tendons that move your fingers and thumb pass through this tunnel in order to get from hand to forearm.

The median nerve travels down your arm, through the carpal tunnel, and into your hand. It carries sensory impulses from the thumb and four fingers on the palm (except for the little finger and half of the ring finger), and carries motor impulses to muscles in the hand, mostly in the thumb. When this nerve is compressed, there is a weakening of these muscles as well as tingling and numbness of the thumb, index and middle fingers.

There are many different mechanisms that can cause increased pressure in the carpal tunnel with resulting compression of the median nerve. The most common is overuse of tendons in the wrist due to repetitive motion, resulting in irritation, swelling and added pressure. Fluid retention associated with pregnancy, diseases such as diabetes and rheumatoid arthritis, tumors of the wrist, fractures of the wrist and thyroid imbalance can also contribute to this condition.

Carpal tunnel syndrome usually starts slowly with tingling in the fingers (especially at night) and aching in the wrist, sometimes extending through the hand and up the forearm. In rare instances, there may be a more rapid onset of the nerve compression, which is likely to cause some pain.

CTS is diagnosed based on a set of physical symptoms, including specific location of pain and loss of sensation in the hand. Your doctor may recommend that you undergo electrical testing of the median nerve to determine the severity of the condition. Nerve Conduction Studies (NCS), performed by specialists, can show abnormalities of median nerve conduction in people with carpal tunnel syndrome.

You may also be examined to make sure that the following conditions, which have similar symptoms, are not present: nerve compression in the neck (herniated cervical disc) or compression in the forearm (pronator syndrome).

For a mild case of carpal tunnel syndrome, your doctor may initially recommend that you wear a splint on your wrist to minimize movement. To prevent overuse, you may be advised to reduce repetitive use of your hand and wrist in activities such as typing by taking a break for a few minutes each hour. Maintaining proper posture at the computer with good support for the wrists is also helpful.

If possible, have your workstation ergonomically designed for your particular type of work. Your doctor or physical therapist may also suggest certain exercises and stretches to increase flexibility in the wrist and fingers. Nonsteroidal anti-inflammatory medication or an anti-inflammatory injection into the carpal canal can reduce swelling and relieve symptoms.

If symptoms persist, you may need a carpal tunnel release, a surgical procedure designed to resolve this problem on a permanent basis. This is almost always an outpatient procedure performed via an open or endoscopic technique and rarely requires a general anesthetic. You will probably be able to return to work within a few days and resume most recreational activities within 3-4 weeks.