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Carpal tunnel syndrome is a compression neuropathy of the median nerve as it goes into a tunnel entering the hand. This is by far the most compression of any of the three peripheral nerve on the upper limb and it is a very disabling and generally painful condition to have. The median nerve is by far the largest nerve of the upper limb as it is the sensory supply of the thumb, index finger, middle finger, and half of the ring finger. This large sensory representation is also the reason why it's called the eye of the hand and when this nerve is compressed, the symptoms of very sensory with a variety of symptoms of pins and needles and numbness and just a general ache in the hand.  Of note is also that this compression at the level of the wrist is associated with vague wrist pain as pain can spread up into the elbow and even up into the neck. This is also associated with weakness of the hand, commonly people feel they drop things out of the hand as the media know supplies the muscles around the thumb.

The pathology of this is poorly understood, and there are a couple of theories. The problem with chronic carpal tunnel syndrome if it's not addressed, the nerve may have secondary degeneration with weakness of the hand and permanent sensory loss. The treatment initially is conservative, and we try to avoid situations that cause the symptoms and for some patients night splinting does help, as well as the option of cortisone injections. In the early stages, cortisone injections can bring temporary relief. Ultimately if the symptoms continue beyond three months, it is best to have a surgical release of the carpal tunnel with release of the scar tissue around the nerves and also freeing up the tendons as the global tunnels are typically associated with stiff hands as well. I usually consider this the surgical treatment for patients that had it for a while or if they have night symptoms that keeps them awake and if there's a generally a suggestion of weak hands.

Please feel free to contact us if you've got any carpal tunnel symptoms.