Hand Conditions

Carpal Tunnel Syndrome

Definition:

Compressive neuropathy (damage/dysfunction) of the median nerve within the carpal tunnel. 

Symptoms:

  • Numbness, tingling, pruritus (itching) and paresthesia (pins-and-needles) mostly at night but can progress to daytime symptoms.
  • Typically gradual in onset and includes the thumb, index, long and thumb side of ring finger.
  • Severe and untreated can result in loss of temperature sensation and thumb weakness.

Pathology:

  • Many factors can be implicated in compression of the median nerve.  It can be acute or chronic (high-energy trauma or low-energy repetitive trauma).  
  • Genetics may predispose a person to have a smaller, narrow carpal tunnel.  
  • Other predisposing factors may include hypothyroidism, obesity, rheumatoid arthritis, diabetes, and pregnancy. 

Treatment:

Non-surgical

  • Rest, activity modifications, night splint, ice and NSAIDs (ibuprofen)
  • Occupational/Physical Therapy
  • Corticosteroid injection

Surgical

  • Indicated when non-operative treatment fails.
  • The transverse carpal ligament (a.k.a. flexor retinaculum), which makes up the “roof” of the tunnel, is arthroscopically incised (released).