Carpal Tunnel Syndrome
Carpal Tunnel Syndrome Description
In the wrist there is a sheath of tough connective tissue which envelopes and protects one nerve (median nerve) and tendons, which attach your muscles to the wrist and hand bones. The carpal tunnel is the space between this sheath (above) and the bones (below) making up the wrist and hand (carpal bones). The term 'carpal tunnel' is also used quite commonly to refer to 'carpal tunnel syndrome' which is a condition where the median nerve is pinched within the tunnel and causes pain and/or numbness of the wrist/hand, typically as a result of repetitive motion such as painting or typing.
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel - a narrow, rigid passageway of ligament and bones at the base of the hand ¾ houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatized.
Medical/Anatomical definition
The carpal tunnel is a fibro-osseous tunnel on the palmar surface of the carpal bones which transmits a number of tendons and the median nerve from the forearm into the hand.
Surface markings are, proximally, the distal wrist crease; distally, the hook of the hamate bone.
The recurrent thenar branch of the median nerve, the motor branch to the thenar eminence, leaves the median nerve in or beyond the carpal tunnel, then curves back over the flexor retinaculum to reach the thenar eminence. It is endangered in carpal tunnel surgery if the incision over the carpal tunnel is made too far laterally (thumb side).
Recommended reading: How To Cure Your Carpal Tunnel.
Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.
Boundaries
The base and walls of the carpal tunnel are a concave bony channel formed by the carpal bones.
The flexor retinaculum, or transverse carpal ligament, forms the roof of the carpal tunnel. It attaches to the scaphoid tubercle and ridge of the trapezium laterally, and to the pisiform and hook of the hamate medially.
From superficial to deep, the structures encountered in exposing the carpal tunnel, are:
Skin
Palmaris longus tendon merging with palmar aponeurosis
Palmaris brevis muscle
Flexor retinaculum
The median nerve is located deep to the flexor retinaculum.
The carpal tunnel transmits:
Flexor pollicis longus tendon,
Median nerve
Flexor digitorum superficialis (flex. dig. sublimis) tendons to the four fingers. All four tendons travel in a common synovial sheath. The tendons to the middle and ring fingers lie superficial to the tendons to the index and little fingers
Flexor digitorum profundus tendons, lying side-by-side. The index finger tendon is separate; the others lie close together.
Relevance
The carpal tunnel is important because the median nerve can be compressed in cases such as the following:
Carpal tunnel syndrome
Wrist dislocations
Fractures around the wrist
Carpal Tunnel Signs & Symptoms
Tingling or numbness in your fingers or hand, especially your thumb, index, middle or ring fingers, but not your little finger. This sensation often occurs while driving a vehicle or holding a phone or a newspaper, or upon awakening. Many people "shake out" their hands to relieve their symptoms.
Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on the front (palm) side of your forearm.
A sense of weakness in your hands and a tendency to drop objects.
Treatment
Most people with carpal tunnel syndrome can be effectively treated with non-surgical methods. A splint that holds your wrist will help relieve nighttime symptoms of tingling & numbness.
Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction. Underlying causes such as diabetes or arthritis should be treated first. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling.
Anti-inflammatory drugs will relieve pain from Carpal Tunnel Syndrome. In some instances an injection of Cortisone will relieve any associated pain.
As a last resort surgery may be advised by your doctor.
Prevention
Relax or reduce your grip
Take frequent breaks
Avoid bending your wrists all theway up & down.
Improve your posture. Sagging shoulders can affect your wrists.
Keep your hands warm.
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