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Carpal Tunnel Syndrome

Where is the Carpal Tunnel?

The carpal tunnel is located at the base of the palm and is surrounded on 3 sides by carpal (wrist) bones and anteriorly by the transverse carpal ligament. Inside the "tunnel" runs the median nerve, flexor tendons, and their synovial sheaths

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a compressive neuropathy of the median nerve at the wrist. Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist.

What are the symptoms of Carpal Tunnel Syndrome?

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. 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.

What causes Carpal Tunnel Syndrome?

  • Activities involving repetitive wrist flexion (eg, assembly packing, computer keyboard work, playing a musical instrument, craftwork)
  • Trauma or wrist fractures
  • Rheumatoid arthritis
  • Gout or pseudogout
  • strongly associated with obesity and Diabetes

How is Carpal Tunnel Syndrome Diagnosed?

Clinicians are often alerted of the diagnosis of CTS by History and Physical exam but there are tests that can be performed to help confirm the diagnosis, such as:

  • Electromyographic (EMG) and nerve conduction studies
  • Magnetic Resonance Imaging (MRI)
  • High Resolution Ultrasound (US)

How is Carpal Tunnel Syndrome treated?

Options include:

  • Conservative management- Occupational Therapy and/or NSAIDS
  • Surgical Procedure- Carpal Tunnel Release
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