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Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition caused by a pinched nerve in the wrist, causing numbness, weakness, and pain in the hand.

Quick Anatomy

  • The carpal tunnel – a narrow, tunnel-like passageway, bound by bones and ligaments, which protects the median nerve and the flexor tendons
  • Carpal (wrist) bones – form the bottom part of the carpal tunnel
  • Transverse carpal ligament – a strong band of connective tissue that attaches to the top of the tunnel
  • Median nerve – travels from the forearm to the hand, and is protected by the carpal tunnel 
    • Controls the sensation in the palm side of the thumb, index, and long fingers
    • Sends signals to move the thumb’s muscles
  • Flexor tendons – also protected by the carpal tunnel
    • Nine tendons which bend the fingers and the thumb
  • Synovium – the tissues surrounding the flexor tendons, which lubricates them and makes it easy for the fingers to move


Compression of the median nerve causes tingling, numbness, weakness of the hand, which we call carpal tunnel syndrome.

  • Tingling or numbness – in the thumb, index, middle and ring fingers, except the little finger. This sensation may radiate from the wrist to the arm.
  • Weakness – dropping objects may be because of the weakness of the pinching muscles of the thumb, or numbness felt from the fingers, wrist, and/or the arms
  • Electric shock-like feeling in the fingers and thumb
  • Pain in the hand and fingers


Carpal tunnel syndrome occurs when the median nerve is compressed, due to the swelling of the synovium. Although in most cases, there is no specific cause of carpal tunnel syndrome, we do have these contributing factors:

  • Heredity/Race – carpal tunnels are smaller in some people, and this is usually hereditary.
  • Anatomic factors – aside from heredity, the carpal tunnel space may become smaller in cases of wrist fracture, dislocation, or arthritis exerting pressure on the median nerve
  • Chronic conditions such as diabetes, wherein there is increased risk for nerve damage, including the median nerve
  • Medical conditions such thyroid problems and kidney disorders
  • More common in women than in men, probably because the carpal tunnel is relatively smaller in women
  • More common in older people, with a peak age range of 45-60 years
  • Hand use and workplace factors – prolonged or repetitive flexing of the wrist (keyboarding and excessive mouse use), or working with vibrating tools may damage the median nerve

Doctor’s Physical Examination

  • Palpating for muscle weakness around the base of the thumb
  • Checking for numbness or diminished sensation in the fingers by lightly touching them with your eyes closed
  • Testing for tingling sensation or numbness in the hands by flexing the wrists (Phalen Sign), tapping (Hoffman-Tinel sign) or pressing down on the median nerve (Carpal Compression test).

Diagnostic Studies

  • X-ray – to rule out other causes of wrist pain, such as fracture or arthritis
  • Electrophysiologic Studies -Electromyography and Nerve Conduction Study – to determine any muscle damage and see the electrical activity in the carpal tunnel


Non-surgical Treatment

With early diagnosis, these conservative managements would be very useful in slowing or stopping the progression of the disease.

  • If the condition is caused by an occupation or specific activity, this has to be modified (e.g., use of wrist rest when using the keyboard), moderated or even stopped, to prevent worsening of the symptoms
  • Bracing or splinting – to keep the wrist from bending, especially during sleeping or other activities where symptoms grow worse.
  • Non-steroidal anti-inflammatory drugs are helpful in relieving pain and inflammation
  • Corticosteroid injection – decreases swelling and inflammation, relieving pressure on the median nerve, therefore relieving the symptoms

Surgical Treatment

In cases where the condition is becoming constant and severe, and the nonsurgical treatments have not been effective, surgery is often advised to prevent permanent nerve damage. However, the risks and complications should be thoroughly discussed with your physician.
Endoscopic method – a small incision is made to insert a small camera (endoscope) which cuts the transverse carpal ligament

  • Open Surgical technique – a cut is made in the palm, and the ligament is divided to increase the size of the tunnel, decreasing pressure on the nerve

That pain you feel in your hand while you are driving, or that tingling sensation while holding your phone which you just try to shake off, or that feeling of clumsiness when you often accidentally drop things? You probably have to discuss those with your physician and have yourself checked. Those may be symptoms of carpal tunnel syndrome, which could result to irreversible nerve damage if left untreated.

Click here to book an appointment with our Orthopedic Specialist to have yourself evaluated.