Carpal Tunnel Syndrome: Fast Facts

There are 2 classes of wrist pain. First pain occurs immediately such as with a traumatic event in which a bone is broken. The second class occurs over a period of time. Arthritis and Carpal Tunnel Syndrome (CTS) are examples. CTS is the most common cause of chronic pain. Frequently it's considered synonymous with wrist pain but it's a distinct entity.

The carpal tunnel is a closed space or "tunnel" located in the middle of the mid palm side of the wrist. A thick ligamentous band covers the space in front and in the back the space is confined by the wrist bones, the radius and ulna. Coursing through the tunnel or space are the flexor tendons and median nerve. "Too much stuff crammed into a small space".

It is thought that pressure builds up within the small space affecting the median nerve - pressure on the median nerve at the wrist manifests as Carpal Tunnel Syndrome. It has never been proven that it is actually the pressure within the carpal tunnel or even how much pressure it takes. Further repetitive movement, exercising and certain activities are associated with carpal tunnel syndrome, but again no specific time frame or repetitive movement has been documented to cause the problem. We do know by experience and anecdotal evidence that activities such as typing or working on a production line doing repetitive movements are associated with CTS.

Carpal Tunnel Syndrome is a Repetitive Strain Injury (RSI) one of the buzz phrases of the 90's and 21st century.

Typical complaints of those with CTS involve numbness, tingling on the palm side of the thumb , index, middle and thumb side of the ring fingers as well as weakness of grip. People affected by median nerve pressure at the wrist will also describe painful or electric shock-like sensation radiating into the hand or back up the forearm. Not everyone has all the classic symptoms but will have some variation or combination. For instance, only one or two fingers may be numb.

Tapping on the carpal tunnel at the wrist may set off unpleasant shock like sensations into the hand. It indicates the median nerve is irritated or compressed at the wrist. Acutely flexing the wrist and holding it in that position increases the pressure on the nerve , again causing the unpleasant sensations radiating into the hand and forearm.

One factor I consider very important is the thick lining around the median nerve and flexor tendons called synovium. People with Carpal Tunnel Syndrome invariably have a thickened swollen synovium. This again increases the content of the carpal tunnel and also presumably the pressure effects.

Individuals with arthritis, hypothyroidism and pregnancy have a greater incidence of CTS. In these conditions and illnesses the common factor is the swollen linings.

The standard confirmatory test for Carpal Tunnel Syndrome is an electric diagnostic study or (EMG). It is a measure of the electrical activity of the median nerve and the muscles enervated by median nerve. Routine x-rays are not much help. MRI may suggest median nerve compression if the contour of the median nerve is altered which is seen on the MRI.

Related Topics: Carpal Tunnel May Predict Diabetes, Repetitive Strain Injury

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