Carpel Tunnel Syndrome

I. General
Out patient surgery
Usually are not hospitalized
An entrapment neuropathy occurring when the median nerve at wrist is compressed by a:\
o Thickened flexor tendon sheath
o Skeletal encroachment
o Edema- as in pregnancy
o Soft tissue mass

II. Causes
Repetitive hand activities
Associated with arthritis, pregnancy and hypothyroidism

III. Anatomy
Carpal tunnel: Bones and ligament forming a narrow tunnel in center of wrist containing tendons
and a major nerve.
Carpal Bones: U-shaped cluster of eight bones at base of palm forming a hard rigid floor and two sides of
the tunnel.
Transverse Carpal ligament: very strong ligament lying across arch of carpal bones forming root of the
tunnel
Median Nerve- conducts sensation

IV. Patho
Wear and tear
o Synovium around tendons becomes thick and sticky due to normal wear and tear of aging process
or repetitive hand movements pressing nerve against the tunnel
Bone dislocation and fracture- previous dislocation or fracture of the wrist causes bone to protrude into the
tunnel; if arthritis present tunnel may become too narrow & put pressure on nerve
Fluid retention- edema causes swelling of tissue in carpal tunnel; symptoms subside after delivery if
pregnancy related

V. Symptoms
Pain (night)
Numbness
Paresthesia
Weakness along median nerve (thumb and first 2 fingers)
Progressive pain and numbness

VI. Diagnosis
Percussion over the median nerve located on inner aspect of wrist with patient report of tingling, numbness
and pain is a positive Tinel’s Sign.

VII. Treatment
Resting splints to prevent hyperextension and prolonged flexion of the wrist
o Night/occupational splints
Avoid repetitive wrist flexion
o Keep wrist in neutral position
o Watch your grip- don’t pick things up with fingertips
o Reduce speed and force
o Conditioning exercises- possible pt consult
Ergonomic Changes at work/home
NSAID’s, Diuretics, pyridoxine (Vit B-6)
Carpal tunnel cortisone injections
Surgical intervention
o Transverse ligament is divided to open the carpal tunnel and relieve pressure on the nerve
and remove thickened synovial tissue