Carpal Tunnel

Carpal Tunnel Syndrome (CTS) is a painful and often debilitating disorder affecting the hands and wrists. The symptoms of carpal tunnel syndrome include numbness and tingling in the hands, primarily the thumb and thumb pad, index, middle, and inner half of the ring fingers. Many sufferers of CTS report increased symptoms at night, making sleep difficult. Advanced stages of carpal tunnel syndrome result in decreased fine dexterity movements of the fingers, such as buttoning a blouse, and reduced grip strength. Also, the thenar pad (palms) may undergo muscle atrophy (shrinking).

Carpal Tunnel Syndrome occurs when the median nerve, one of the major nerves that supplies the upper extremity, is compressed in the carpal tunnel: a narrow passageway in the wrist formed by the carpal bones and the transverse carpal ligament- a strip of tendon that supports the wrist from the bottom.

The contents of the carpal tunnel include the median nerve and the flexor tendons of the wrist and fingers (the tendons that enable you to form a fist). Carpal tunnel syndrome is often the result of a combination of factors that press on the median nerve and tendons in the carpal tunnel. The disorder can also be due to a congenital (born with) predisposition where the carpal tunnel is smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems of the carpal (wrist) bones; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. In some cases no cause can be identified.

By the time you feel neuropathic symptoms (numbness, pins and needles, loss of grip strength), it usually means that the median nerve is under compression in the wrist, and possibly at the nerve root level in the neck. The first order of business is to schedule an appointment with a specialist who treats carpal tunnel syndrome.

There are a few simple orthopedic test that can be useful for diagnosing CTS. The first is called Tinel’s test: with the tip of your middle finger, firmly tap the underside of the wrist in the suspected hand 3-5 times. If this tapping causes a sharp pain to travel into the palm, thumb or index finger, it is a sign of carpal tunnel syndrome. The second test is called Phalen’s maneuver: simply press your hands in front of you as in a prayer, and hold for 15 seconds. If you feel tingling or numbness in your affected hand, it is also a sign of CTS. The thumb opposition test is done by pinching together your thumb and small finger. If someone can separate them with little effort, it suggests denervation (median nerve-thenar branch) of the thenar (thumb pad) muscle, another sign of CTS.

The definitive diagonsis for CTS is if the symptoms of numbness and tingling affect the thumb, index, middle, and inner half of the ring finger, and if the numbness and tingling is strong enough to keep you awake at night.

A physician/hand specialist may order a nerve conduction study that measures nerve conductivity of the median nerve. This can be helpful in the diagnosis, although it may produce false negative tests.

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