What is the carpal tunnel?

The carpal tunnel is a narrow passageway located on the palm side of the wrist. It is formed by the carpal bones and a strong ligament called the transverse carpal ligament. The median nerve, along with tendons that control finger movement, passes through this tunnel. When the median nerve becomes compressed or irritated, it leads to the development of carpal tunnel syndrome.

Diagram of the carpal tunnel in the hand.
The carpal tunnel is made up the bones underneath, the transverse carpal ligament on top, and the tendons and nerves inside of it.

Causes of carpal tunnel syndrome

Carpal tunnel syndrome is often caused by a combination of factors, including:

• Repetitive hand and wrist movements: Engaging in repetitive motions involving the hand and wrist, such as typing, using vibrating tools, or playing musical instruments, can contribute to the development of CTS.

• Nerve-damaging conditions: Certain conditions, such as diabetes, rheumatoid arthritis, and thyroid dysfunction, can increase the risk of nerve compression and the onset of carpal tunnel syndrome.

• Hormonal changes: Hormonal changes that occur during pregnancy can lead to swelling and fluid retention, potentially compressing the median nerve and causing CTS symptoms.

• Anatomical factors: Certain anatomical variations, including a smaller carpal tunnel size or a larger median nerve, may make individuals more susceptible to developing CTS.

Symptoms of carpal tunnel syndrome

The symptoms of carpal tunnel syndrome typically include:

• Numbness or tingling: Individuals may experience numbness, tingling, or a "pins and needles" sensation in the thumb, index finger, middle finger, and half of the ring finger.

• Hand weakness: Weakened grip strength and difficulty holding or grasping objects can occur due to CTS.

• Pain and discomfort: Individuals may experience pain or aching in the hand, wrist, forearm, or even radiating up the arm.

• Nighttime symptoms: Symptoms may worsen during the night, causing discomfort and sleep disturbances.

Diagnosis of carpal tunnel syndrome

Healthcare professionals employ various diagnostic methods to confirm carpal tunnel syndrome, including:

• Medical history and physical examination: A detailed history of symptoms and a physical examination can help evaluate hand and wrist function and identify any areas of weakness, numbness, or tenderness.

• Nerve conduction studies: Nerve conduction studies measure the speed and strength of electrical impulses in the nerves, helping to determine the extent of nerve compression.

• Electromyography (EMG): EMG assesses muscle activity and can help differentiate between carpal tunnel syndrome and other nerve-related conditions.

• Ultrasound imaging: Ultrasound can visualise the median nerve and assess for any abnormalities or compression.

With long standing carpal tunnel syndrome, there can be wasting of the muscles at the base of the thumb (thenar muscles).

Treatment for carpal tunnel syndrome

The treatment of carpal tunnel syndrome aims to relieve symptoms and reduce inflammation. Common approaches include:

• Wrist splinting: Wearing a wrist splint, especially at night, can help keep the wrist in a neutral position, alleviating pressure on the median nerve.

• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to reduce pain and inflammation.

• Occupational and lifestyle modifications: Making adjustments to work ergonomics, taking regular breaks, and avoiding repetitive hand movements can help reduce symptoms.

• Corticosteroid injections: In severe cases, corticosteroid injections into the carpal tunnel can provide temporary relief by reducing inflammation.

• Surgery: Carpal tunnel release surgery may be recommended for persistent or severe cases that do not respond to conservative treatments. The procedure involves cutting the transverse carpal ligament to enlarge the carpal tunnel and alleviate pressure on the median nerve.

Wearing a wrist splint at night time can help treat carpal tunnel syndrome.

Exercises for carpal tunnel syndrome

In addition to medical treatments, certain exercises can help improve symptoms and prevent further complications. These exercises typically focus on stretching and strengthening the wrist and hand muscles. Examples include:

• Wrist flexor stretch: Gently bend the wrist backward with the help of the opposite hand until a gentle stretch is felt.

• Wrist extensor stretch: Gently bend the wrist forward with the help of the opposite hand until a gentle stretch is felt.

• Finger and thumb opposition exercises: Touch the tip of each finger to the tip of the thumb, one at a time, repeating the movement.

• Hand and finger squeezes: Squeeze a soft ball or stress ball in your hand, holding the squeeze for a few seconds before releasing.

• Finger and wrist extensions: Extend the fingers and wrist fully, holding the stretch for a few seconds before relaxing.

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