Introduction:

Carpal tunnel syndrome (CTS), or median neuropathy, is a pathologic condition in which the median nerve is compressed at the wrist, leading to pain, paresthesia (tingling), numbness, and weakness in the area of the hand supplied by the median nerve. CTS is a common peripheral nerve entrapment syndrome that has received a lot of attention because of its association with work-related disability.

Anatomy:

The eight carpal bones on the back of the wrist form one half of the carpal tunnel, while the transverse carpal ligament, positioned on the anterior (front) side of the wrist forms the remaining half.  The size of the carpal tunnel is about the size of the index finger in diameter, and is the narrow passageway in which the nine flexor tendons and median nerve pass through in order to supply function, feeling and movement to the thumb, index, middle, and one half of the ring finger.

Discussion:

Treatment for carpal tunnel syndrome is based on the severity of the condition (the presence of nerve damage), and whether other treatment has helped. If treated early, carpal tunnel symptoms usually resolve with nonsurgical treatments.  If symptoms are mild, with occasional tingling, numbness, weakness, or pain, one to two weeks of home treatment are likely to relieve symptoms.  If home treatment does not help, or if symptoms are more severe (including longstanding loss of feeling in the fingers or hand, or the inability to perform simple hand movements such as holding objects or pinching), further consideration for more invasive treatment should be considered after a more complete diagnostic work up.

Surgery is sometimes recommended when other treatment has not helped, if the symptoms have persisted for a long time, or if there is nerve damage or the risk of nerve damage. Surgery involves cutting the ligament that forms the roof of the carpal tunnel. This relieves the pressure on the median nerve, which eases or completely resolves the symptoms associated with carpal tunnel syndrome.  Although surgery is usually a success, in some cases it does not completely relieve the numbness and pain in the fingers or hand. This may be the case if there has been permanent nerve damage caused by long standing carpal tunnel syndrome or by other health problems such as diabetes.