Carpal Tunnel Syndrome

Carpal tunnel syndrome is the most common compression neuropathy. This means that the median nerve is compressed at the level of the wrist in a confined space (tunnel) known as the carpal tunnel. The nerve runs with nine other tendons in this confined space. The tendons are individually wrapped with a thick synovial sheath and swelling or thickening of these synovial sheaths might be a reason for carpal tunnel syndrome. In more than 95% of carpal tunnel syndrome cases the cause is not known and we call it idiopathic carpal tunnel syndrome. Most of these cases are associated with osteoarthritis of the hands. Some secondary causes for carpal tunnel syndrome are pregnancy (especially post-partum), hypothyroidism, rheumatoid arthritis and even gout.

In more than 95% of carpal tunnel syndrome cases the cause is not known.

Symphtoms

The median nerve is commonly referred to as the eye of the hand as it is the main sensory nerve of the hand. It’s main function is to feel and all the symptoms are related to sensation. The symptoms are initially pins and needles in the median nerve distribution: thumb, index finger, middle finger and the half of the ring finger. The symptoms can vary from a loss of sensation, warm or cold sensations, hypersensitive fingers to an uncomfortable burning sensation. In advanced cases, the hand can become weak as the median nerve also supplies some thumb muscles that help with power grip.

Night symptoms are very prominent in carpal tunnel syndrome and results in frustration as people are unable to sleep. Patients commonly try all sorts of tricks (shaking hand, elevating it and getting up from their bed) to get rid of pins and needles and even burning pain at night.

Diagram of median nerve sensory distribution

The median nerve is the main sensory nerve of the hand.

Treatment

Carpal tunnel syndrome is a mechanical problem (nerve being compressed in a confined space) and there is no oral medication or any other treatment modality that can reverse the mechanical problem. Night splints may give relief for night symptoms and steroid (cortisone) injections may give temporary relief. The definitive treatment is a carpal tunnel release, which is an operation where the transverse carpal fascia (the roof of carpal tunnel) is released and the nerve is freed.

Diagram of incision and opening roof of tunnel


Potential Complications after the Operation

Incision and dissection of the carpal tunnel

Expectations after the operation

Medium Nerve

Rehabilitation after the Operation

Exercises

Active Wrist Exercises

Tendon Glide Exercise