The carpal tunnel is a narrow passage inside the wrist formed by bone at the bottom and the transverse carpal ligament on top. The median nerve and adjacent tendons run from the forearm into the palm to control the thumb and first three fingers. Carpal tunnel syndrome, or median nerve entrapment, occurs when the median nerve is pinched at the wrist where the carpal tunnel is found. Repetitive strain of the carpal ligament causes inflammation or swelling. This swelling then presses on the carpal tunnel and compresses the median nerve causing carpal tunnel symptoms. Typical symptoms include pain, tingling, or numbness in the hand and fingers. Other relevant symptoms include waking at night with pain, shooting pain in the wrist and/or forearm, or a weakened grip. Dropping things, having difficulty buttoning clothes, feeling like the fingers are swollen (even if they're not), and having trouble making a fist are all symptoms patients have presented with as well. Not all cases of pain are due to carpal tunnel syndrome so some techniques will be used to establish the specific cause of symptoms. A tapping test, where the doctor will tap on the inside of the wrist, or a wrist flexion test, where the doctor will ask the patient to place the backs of the hands together with the fingers pointing down, may be used in diagnosis. If either or both cause pain and shock-like tingling then carpal tunnel syndrome is highly suspected. This diagnosis can be confirmed using a nerve conduction study on the median nerve; the speed of transmissions along the median nerve will be slower in cases of carpal tunnel syndrome. Most of the time, conservative treatment of carpal tunnel syndrome is successful. These include resting the affected wrist, stretching and strengthening the wrist and forearm, reducing the swelling using ice or anti-inflammatory medications, and, in more advanced cases, steroid injections of cortisone aimed at reducing swelling and pain. However, in some cases, the pain persists and t he symptoms continue to affect daily life and simple despite all other attempts at treatment. Additionally, electromyographs (EMG) showing muscle weakness and nerve conduction studies indicating nerve damage increase the urgency with which the carpal tunnel syndrome must be treated. At this point, surgery to cut the carpal ligament to release the median nerve is the final treatment. Once the procedure is done, the ligament heals back but now with enough space for the median nerve which relieves the symptoms.
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