Carpal tunnel syndrome is essentially a pinched nerve in the wrist. Within the wrist lies a narrow passage called the carpal tunnel, where the median nerve and nine tendons travel from the forearm into the hand. The condition develops when swelling inside this tunnel compresses the median nerve.

CAUSES

Pressure on the median nerve within the carpal tunnel can occur due to several factors:

• Tenosynovitis: Swelling of the lining of the flexor tendons.
• Trauma: Joint dislocations or fractures can narrow the tunnel.
• Arthritis: Joint inflammation may reduce space within the tunnel.
• Pregnancy: Fluid build-up during pregnancy can increase pressure.

Additional factors such as thyroid conditions, rheumatoid arthritis, and diabetes are also associated with carpal tunnel syndrome. Ultimately, numerous causes may contribute to the development of this condition.

SIGNS AND SYMPTOMS

Common symptoms of carpal tunnel syndrome include:

• Pain in the wrist and hand
• Numbness and tingling, particularly in the thumb, index, middle, and ring fingers
• Weak grip strength
• Occasional clumsiness and a tendency to drop objects

Symptoms often occur at night but may also interfere with daily activities like driving or reading. In severe cases, persistent pressure on the nerve may lead to permanent loss of sensation and strength.

DIAGNOSIS

Diagnosing carpal tunnel syndrome involves several steps:

• Medical History: A detailed review of symptoms, hand usage, and any previous injuries.
• Imaging: X-rays may be used to identify arthritis or fractures.
• Laboratory Tests: To rule out conditions that might contribute to the syndrome.
• Electrodiagnostic Studies: These tests help confirm the diagnosis and assess for other nerve issues.

TREATMENT

Initial treatment for carpal tunnel syndrome often does not require surgery. Non-surgical options include:

• Activity Modification: Changing hand usage patterns to reduce nerve pressure.
• Wrist Splinting: Keeping the wrist in a neutral position, especially at night, to alleviate symptoms.
• Steroid Injections: Administered directly into the carpal tunnel to reduce swelling.

If symptoms are severe or do not improve with conservative methods, surgery may be necessary. The surgical procedure involves cutting the ligament at the palm side of the wrist to enlarge the tunnel and relieve nerve pressure. Post-surgery, patients may experience soreness around the incision site, and recovery—along with the resolution of numbness and tingling—can take several months. In some severe cases, symptoms might not completely resolve even after surgery.