Carpal Tunnel Syndrome

The carpal tunnel is a narrow passageway located on the palm side of the wrist. It contains the flexor tendons, which allow the fingers to bend, and the median nerve, which provides sensation to most of the fingers and part of the hand. Specialised tissues surround and lubricate the flexor tendons, enabling smooth finger movement.

Carpal tunnel syndrome occurs when these tissues become swollen, reducing the space within the carpal tunnel and placing pressure on the median nerve.

Some people are born with naturally narrower carpal tunnels. In others, narrowing of the tunnel and compression of the median nerve may result from repetitive hand and wrist movements. Certain medical conditions, including hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, and an overactive pituitary gland, as well as hormonal changes, may increase the risk of developing carpal tunnel syndrome. The presence of a cyst or tumour within the carpal tunnel can also contribute to symptoms. In addition, wrist injuries, fractures, and sprains may trigger or worsen the condition.

Symptoms

Symptoms are often more noticeable at night and may include:

• Numbness and tingling in the thumb, index finger, middle finger, and part of the ring finger
• Pain or burning in the hand and wrist that may radiate up the arm towards the elbow
• Reduced sensation in the hand
• Weakness of the hand and decreased grip strength

Diagnosis and Treatment Options

Carpal tunnel syndrome is diagnosed through a detailed medical history and physical examination. Additional investigations may include X-rays and blood tests to identify or rule out underlying conditions such as diabetes, arthritis, or thyroid disorders.

You may also be referred to a neurologist for nerve conduction studies and electromyography (EMG) to assess the function of the median nerve and the electrical activity of the muscles.

Surgery

If surgery is required, a small incision is made in the wrist, or in both the wrist and palm, depending on the surgical technique used. A thin, flexible tube with a camera (endoscope) may be inserted to allow the surgeon to view the structures within the carpal tunnel.

During the procedure, the carpal ligament is divided to relieve pressure on the median nerve. Following surgery, the ligament heals through the formation of scar tissue, creating more space within the carpal tunnel and reducing compression of the nerve.