Carpal Tunnel Syndrome: Causes, Diagnosis and Treatment

Carpal tunnel syndrome can result from any condition that causes pressure over the median nerve as it passes through the carpal tunnel.

Before reading further it would be good to first see Wrist Anatomy (skip if you have already done so).

• five times more common in women
• usually between the age of 40 to 60 years
• dominant limb is more commonly involved

Disease and conditions that can cause it include

• displaced fracture of the distal part of Radius bone
• inflammation from infections, Rheumatoid Arthritis and Gout
• tumors such as Xanthoma or Ganglion of wrist
• use of vibrating machinery
• Diabetes Mellitus and Obesity
• Amyloidosis
• typists who work for long hours
• pregnancy

Symptoms are produced by inflammation and pressure on the median nerve. They include

• abnormal sensations are present in the palm, thumb, middle and index fingers
• pain, numbness and burning sensation (occur after several hours of sleep and cause the patient to wake up)
• exercising, rubbing or shaking the hand may produce relief from pain
• flexion of the wrist can produce a increase in the symptoms (Phalen test)
• pressure on the front of the wrist can also cause a increase in abnormal sensation (Tinel test)

Investigations required to confirm the diagnosis include

• X ray of the wrist to see for any malunited fracture or bony growth.
• MRI scan of the wrist can show good images of the bones and other tissues. Swelling and nerve compression can be visualized.

Treatment includes

• splintage of the wrist in neutral position (neither extended nor flexed)
• use of NSAIDs (drugs such as asprin, diclofenac and ibuprofen)
• injection of steroid into the carpal tunnel
• multivitamin supplements
• if there is no response to the above treatment methods then surgical release of the flexor retinaculum is done.

The green coloured flexor retinaculum (transverse carpal ligament) in this graphic is incised during surgery.

Frequently Asked Questions

When can I expect cure with non-operative treatment?

Cure with non-operative treatment can be expected when

• age is less than 50 years
• symptoms have been present for less than 10 months
• abnormal sensations are occasionally present

Can I have recurrence after surgery for Carpal tunnel syndrome?

Yes recurrence can occur and re operation may be required. Recurrence usually occurs due to the continuation of the disease process in the carpal tunnel and not due to any lapse during surgery.

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 30th March 2009.

Other causes of wrist pain...

De Quervain Disease

Ganglion

Wrist Fracture

Scaphoid Fracture

Madelung Deformity

Go back to Wrist Pain from Carpal Tunnel Syndrome