Carpal tunnel syndrome refers to entrapment of the median nerve at the wrist underneath the carpal ligament. The median nerve supplies sensation to the palmar side of the first 3 digits as well as motor innervation to a few muscles in the hand/thumb.
Causes
Carpal tunnel syndrome occurs as a result of compression of the median nerve.
In general, anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. The nerve can be predisposed to injury with repetitive vibration (such as working with a jackhammer), repeated exposure to cold environments (working in a meat processing plant), with certain systemic diseases such as thyroid disease, during pregnancy, etc.
Symptoms
Tingling or numbness in your fingers or hand, especially your thumb and index, middle or ring fingers, but not your little finger. This sensation often occurs while holding a steering wheel, phone or newspaper or upon awakening. Many people “shake out” their hands to try to relieve their symptoms. As the disorder progresses, the numb feeling may become constant.
Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on the palm side of your forearm.
A sense of weakness in your hands and a tendency to drop objects may occur with more advanced cases.
Treatment
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The median nerve can be “hydrodissected” under ultrasound. In this ultrasound-guided injection procedure, saline is injected around the nerve to free up the nerve from any restrictive adhesions. Occasionally, cortisone will be added to decrease any inflammation around the nerve.