Living with Carpal Tunnel Syndrome

The carpal bones are one of four bones that make an arch area across the wrist. The "Carpal tunnel" refers to the bones, ligaments and the tendons that surround the median nerve. The function of this nerve is to supply sensation to the thumb, middle and index fingers, as well as a portion of the ring finger. It also allows the muscles of the hand and thumb, which provides movement. The median nerve itself is situated along the thumb area of each hand, and when carpal tunnel syndrome occurs there may be weakness, tingling, deterioration of the muscles or numbness in the hand, it can occur with or without pain. Often surgery is used as a method of treatment but there may be less invasive methods of dealing with the situation.

The carpal arch has the flexor retinaculum in front of it which is a strong ligament holding the bones in position and the gap between the four bones is called the carpal tunnel. Also in the tunnel are the median nerve and the tendons all vying for position in a relatively narrow gap. Repetitive tasks using the wrist such as cutting hair, using a keyboard or even playing a piano can cause the median nerve to be compressed and then inflamed. When this compression occurs the nerve cannot transmits the signals to parts of the hand. These signals are sent to the palm, the first three and a half fingers and also the thumb. Additional symptoms on the outside edge of the hand covered by the little finger are not governed by the carpal tunnel as they under the control of the ulnar nerve.

Carpal tunnel syndrome is normally associated with either hand or wrist pain, often worse at night and it may be severe enough to keep you awake. Sometimes if feels like an electric current, is passed through either the hand or the wrist or both. There are no standard symptoms but the pain is often accentuated when the wrist is bent in a forward motion.

When compression of the median nerve is suspected, an electromyelogram or EMG, which determines the conductivity of the nerves, is used to diagnose the problem. The signals should be sent to the central nervous system and a probe is used on the nerve in the hand and on the arm, a current is passed through and how much of the current is transmitted through the nerve is measured. Conditions such as diabetes, obesity, pregnancy, the menopause, broken or dislocated bones in the wrist, and arthritis can aggravate the pressure.

However many other treatments can be attempted, as few cases actually need to be resolved by surgery. When surgery occurs the ligament, the flexor retinaculum is cut to relieve the pressure. However, the condition can be caused by the deterioration of the carpal bones, which press on the nerve when they break down. In other cases, repetitive movements cause the tendons to swell and as they expand with the inflammation, they begin to press on the nerve and cause pain.

Whilst an EMG registers and measures how much of the current the nerve transmits, it cannot differentiate between what is causing the problem. When tendonitis is the cause, the symptoms may not need surgery. Excessive movement of the muscles causes them to contract and shorten, and this has a knock on effect on the tendon as this connects the muscle to the bone. Sometimes this will lead to symptoms of carpal tunnel syndrome.

Surgery should be a last resort often gentle manipulation, stretching and physiotherapy which encourages a better typing posture, can cure the problem. This method is often combined with ant inflammatory medicines and or cortisone treatment to reduce the swelling. Often these alternatives are attempted for several months before resorting to surgery. Of course, if the other methods fail to solve the problem then surgery can be undertaken later.