What is carpal tunnel syndrome?

So what is carpal tunnel? So carpal tunnel, the carpal tunnel sits just at the over the flexor aspect of the wrist where it enters the hand here. And it's the carpal tunnel syndrome is where the median nerve as it passes through the carpal tunnel is thought to be compressed and which leads to changes in the nerve. The carpal tunnel is a tight space. It's accompanied by nine flexor tendons in that space. And it's the only nerve sitting in that space. If we imagine the carpal tunnel has three walls, the floor and the side walls are formed by bone. And the roof is formed by the flexor retinaculum, which is a thick, almost like canvas type covering. And carpal tunnel is when the nerve is thought to be tight or compressed, and it gives rise to numbness initially and tingling in the median nerve distribution, which is typically the thumb, the index finger, the middle finger, and often half of the ring finger, the thumb side of these. So typically those digits are involved and half of the ring finger. So in the early stages, you give rise to sensory symptoms, because the sensory fibers are the smallest, and they often are affected first. When the pressure on the nerve is maintained, or it's been going on for quite a while, then the motor side of the nerve can be involved as well, and the fibers are slightly larger, and that starts to give rise to weakness, and wasting in the thenar eminence here, and people will complain about loss of grip strength as well and start dropping cups and mugs. But the main predominant symptom is numbness in the median nerve distribution. I think it becomes particularly troublesome for people when if it starts waking them up at night and that's a particular problem and that's often because when we sleep at night we tend to flex our wrists and that's what's thought to make it make the condition worse in those affected at night as well. Certain occupations can make it worse. People working with vibration tools etc. People working on again on keyboards who may be flexing their wrists significantly can cause a problem. If you suspect carpal tunnel then the test to do is a nerve conduction study which is done by a neurophysiologist and that often confirms how severe or otherwise it is. So they tend to grade it as mild, moderate, moderately severe or severe. With the mild and moderate end, these can often be treated by a combination of steroid injection and wearing splints at night, and that tends to help a lot of people. With the more moderately severe and severe, then if the, often the way to treat these is through a small operation done and carried out under local anesthetic and that works quite well as well. Sometimes you have to be very careful because you may have a diabetic presenting with what looks like carpal tunnel and then you do the nerve conduction studies and you find actually they've got a peripheral neuropathy. So it's not a simple carpal tunnel or compressive neuropathy, in which case you have to advise them that this is not due to the median nerve compression that you get in carpal tunnel syndrome and there are other factors at play, but that's carpal tunnel in a nutshell really.