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Carpal Tunnel Syndrome

1st January 2019
By Lisa Keenan

Carpal tunnel is a compression of the median nerve at the level of the wrist. There are 8 carpal bones that form the base of the tunnel. The top of the tunnel is formed by the transverse carpal ligament. The tunnel formed by these structures (the carpal tunnel) has all the structures inside it that run down the palm side of the hand/arm. These include your blood vessels, tendons to your muscles and your nerve (which is called your median nerve). The median nerve is the structure that sits the most superficial in the tunnel. Therefore, if there is less room in the tunnel the structure that is most susceptible to compression is the median nerve.


The symptoms of carpal tunnel are pins and needle +/- numbness over the thumb side of the hand. See diagram. This is varied in different people; it includes the thumb and usually includes the index and middle fingers. In some people there may be half of the ring finger (the thumb side). Carpal tunnel syndrome may also be accompanied by pain, burning in the palm and weakness. Symptoms typically start night and worsen gradually.


Whilst there is not a known cause with carpal tunnel syndrome genetics do play a big factor. Other issues that increase the prevalence are things that put more pressure on the median nerve. These include obesity, trauma, diabetes, hypothyroidism and arthritis. There can also be internal factors that put pressure on the nerve such as lipomas and ganglions. It is unclear whether repetitive and work-related use increases the prevalence of carpal tunnel syndrome.


Carpal tunnel syndrome may be diagnoses by performing the Phalen’s and Tinel’s test. The Phalen’s test is performed by bending your wrist towards the palm and holding for 30-60 seconds. A positive test is experiencing pins and needles +/- numbness in the median nerve distribution. The Tinel’s test is done by tapping the median nerve (with your finger) at the wrist. A positive test is pins and needles in the median nerve distribution. In addition, nerve conduction studies are useful in diagnosing carpal tunnel syndrome.

Carpal tunnel syndrome can be treated by night splints. These work best if they are fitted and made by therapists of hand therapy. The night splints are effective as they keep the wrist in a straight splint all night. The straight position of the wrist is the best position for the carpal tunnel. When the wrist is straight there is the most amount of space available in the wrist and therefore there is less compression of the median nerve. Therapist of hand therapy treatments may also include median nerve glides. If this does not work patients will usually require surgery.









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