• Sarah Kosoy

What is Carpal Tunnel Syndrome?

Anna arrived at her doctor’s appointment in quite an anxious mood. Leading up to this day, she had been experiencing numbness and tingling that radiated from her wrist to her index finger. Initially, her symptoms appeared infrequently, but as time went on, they became more and more regular. Left with no choice, she decided to call up her doctor to figure out what was wrong. After lengthy examinations, the doctor diagnosed her with carpal tunnel syndrome.

Anna’s doctor explained that carpal tunnel syndrome is a condition where the median nerve, running through the length of the arm and the hand, is pinched at the carpal tunnel. When the median nerve functions normally, it regulates the feeling and motion of all fingers, except the pinky, and serves as a communication line to the base of the thumb. The carpal tunnel is located on the bottom of the wrist, housing not only the median nerve, but also the nine tendons that allow the fingers to bend. Above this convergence is the transverse carpal ligament, which acts as a roof for the carpal tunnel. These ligaments are rigid structures, preventing them from expanding with increased pressure in the tunnel.

Anna became curious and asked her doctor why this condition caused numbness and tingling. He further explained that the carpal tunnel is a relatively cramped area, making it vulnerable to increased pressure; increased pressure directly impacts the function of the median nerve and can cause symptoms such as numbness and tingling, burning, or itching of the index and middle fingers. Those with carpal tunnel syndrome may also experience pain at the wrist, although this is usually not one of the first symptoms to appear. As the condition progresses, these symptoms will last and may even worsen, making it difficult to feel one’s fingers. In advanced cases, nerve impulses are slowed, hand coordination decreases, and the muscles at the base of the thumb weaken and shrink. Luckily, Anna caught this condition in time and did not experience any of these severe symptoms.

Towards the end of her appointment, the doctor asked her if she had participated in activities that would aggravate her median nerve, as there are certain factors that heighten the chances of developing carpal tunnel syndrome. Women are automatically at increased risk, due to the small size of their carpal tunnels. Activities that require repetitive wrist movements, such as typing, can both trigger and aggravate this disorder. Hyperthyroidism, obesity, and rheumatoid arthritis are all conditions known to be affiliated with carpal tunnel syndrome.

Doctors diagnose carpal tunnel syndrome in a variety of ways. For Anna, her doctor first performed a sensation test, where the palms of the hand and the back side of the fingers are tapped. The same test may also be done on the forearm and arm, in order to rule out other conditions with similar symptoms. Hand surgeons typically examine a patient by putting direct pressure on the median nerve, in order to trigger the symptoms of carpal tunnel syndrome. These types of tests include Phalen’s maneuver, the Tinsel’s test, and a compression test. Electrodiagnostic studies (EMG) are used to monitor nerve function within the carpal tunnel. This test can also diagnose other conditions that cause similar symptoms to carpal tunnel syndrome, including diabetic neuropathy. Magnetic Resonance Imaging (MRI) captures the size of the median nerve and is used to indicate increased carpal tunnel pressure. It also diagnoses injuries, such as tendinitis, that cause numbness and tingling.

Because carpal tunnel syndrome is a progressive condition, effectiveness of treatment is dependent on how early it is detected. Anna received her diagnosis before her condition worsened and had a very good prognosis. In the early stages, limiting hand and wrist movements, as well as incorporating nerve gliding exercises, can prevent further discomfort associated with carpal tunnel syndrome. Doctors may also advise a splint to be worn at the wrist, in order to limit the pinching of the median nerve. Other non surgical treatments include anti-inflammatory drugs and steroid injections. These treatments are typically administered before carpal tunnel syndrome has progressed. Carpal tunnel release surgery is dubbed the treatment with the highest success rate. This surgical procedure widens the carpal tunnel, alleviating median nerve compression.

Anna left her appointment in good spirits, thankful that she did not ignore her symptoms. Now, she can look forward to a complete recovery.