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Carpal Tunnel Syndrome

What is the Carpal Tunnel ?
The Carpal Tunnel is a passageway in your wrist through which multiple important blood vessels, nerves and tendons enter your hand.

The bottom and sides of this tunnel are formed by wrist bones and the top of the tunnel is covered by a strong band of connective tissue called a ligament. This tunnel also contains nine tendons that connect muscles to bones and bend your fingers and thumb. These tendons are covered with a lubricating membrane called synovium which may enlarge and swell under some circumstances. If the swelling is sufficient it may cause the median nerve to be pressed up against this strong ligament which may result in numbness, tingling in your hand, clumsiness or pain

What is the Carpal Tunnel Syndrome?
Swelling of the synovium, the lining around the tendons (blue in picture to the right), compresses the nerve supplying the hand. This causes pain and limitation of hand function.
If you feel a numbness or tingling in your hand, especially at night you might have carpal tunnel syndrome. Maybe you experience clumsiness in handling objects or sometimes you feel a pain that goes up your arm. These may be the symptoms of carpal tunnel syndrome.

How is it diagnosed?

numbness and tingling in the hands, especially when these symptoms occur at night and after use of the hands
decreased feeling in your thumb, index, and long finger
the presence in your hand of an electric-like shock or tingling (like hitting your "funny bone") when your doctor taps over the course of the median nerve at the wrist
the reproduction of your symptoms by holding your wrists in a bent down position for one minute

In some cases your doctor may recommend a special test called a nerve conduction study. This test, done by a specialist, determines the severity of the pressure on the median nerve and may aid your orthopedic surgeon in making a diagnosis and forming a treatment plan.

How is it treated?

1. Mild cases may be treated by applying a brace or splint which is usually worn at night and keeps your wrist from bending. Resting your wrist allows the swollen and inflamed synovial membranes to shrink; this relieves the pressure on the nerve.
Comfy Carpal Tunnel Splint - Non-bulky splint Comfy Resting Hand Splint - Great for at night

2. If you believe your problem is aggravated at your work, sometimes simple changes can make a difference. For people who sit at a desk or keyboard, the working surface should be adjusted so that the majority of work can be performed with the wrist in neutral position—not bent upwards or downwards. This can sometimes be accomplished by simple adjustment of the chair.

3. These swollen membranes may also be reduced in size by medications taken by mouth called non-steroidal anti-inflammatory medicines (Advil, ibuprofin, aleve, celebrix, among many others). In more severe cases, your doctor may advise a cortisone injection into the carpal tunnel. This medicine spreads around the swollen synovial membranes surrounding the tendons and shrinks them, and, in turn, relieves the pressure on the median nerve. The dosage of cortisone is small and when used in this manner it usually has no harmful side effects. The effectiveness of non-surgical treatment is often dependent on early diagnosis and treatment.

4. In those patients who do not gain relief from these non-surgical measures it may be necessary to perform surgery. The site of the operation is made pain-free by local anesthesia injected either into the wrist and hand or higher up in the arm. This may be done by your orthopaedic surgeon or an anesthesia doctor. The surgery itself is called a "release" - cutting the ligament that forms the roof of the carpal tunnel to relieve the pressure on the median nerve. The surgery is usually performed in an outpatient facility and you are generally not required to stay over night.

What causes it?

Anything that causes swelling, thickening or irritation of the synovial membranes around the tendons in the carpal tunnel can result in pressure on the median nerve.

Some common causes and associated conditions are:

repetitive and forceful grasping with the hands
repetitive bending of the wrist
broken or dislocated bones in the wrist which produce swelling
arthritis, especially the rheumatoid type
thyroid gland imbalance
sugar diabetes
hormonal changes associated with menopause
pregnancy

Although any of the above may be present, most cases have no known cause.

This brochure has been prepared by the Arnold Rotter MD and is intended to contain current information on the subject from recognized authorities. However, it should not be construed as excluding other acceptable viewpoints.

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Lenjoy Medical Engineering, Inc.
13112 S. Crenshaw Blvd
GARDENA, CA 90249-2466
Email: info@comfysplints.com
PHONE: 800-582-5332
FAX: 310-353-2484