Carpal Tunnel Syndrome

Symptoms related to problems from the carpal tunnel are a very frequent cause of patient coming into my office. Very often the diagnosis has been missed, ignored or misdiagnosed because of nonspecific complaints the patient demonstrates. The carpal tunnel is a joint in the lower forearm formed by the bones in the wrist and the distal ends of the radius and ulnar. It is through the “carpal tunnel” that the so-called median nerve runs into the hand, in particular, to the thumb and middle three fingers. It does not go to the 5th finger, which is why symptoms of carpal tunnel syndrome will rarely if ever, affect the 5th finger and will primarily affect the side of the hand closest to the thumb and the fingers closest to the thumb.

The symptoms of carpal tunnel may go from the wrist down to the hand to the fingers, or may be radiated in a retrograde fashion backwards and up the forearm. Typically, patients may complain of numbness in the thumb and middle fingers, pain and unusual sensations in the same distribution. As the carpal tunnel progresses, there may be dropping of objects, difficulty in fine movement for the patient, and the patient very often will complain of waking up at night with an exaggeration of their symptoms.

From a physical exam point of view, percussion of the median nerve can usually reproduce the symptoms and the diagnosis can be very easily confirmed with nerve conduction studies. In advanced cases, there may be a wasting/loss of the muscle at the base of the thumb and at this point in time the symptoms may not be reversible.

The diagnosis having been made, the treatment would be to first try and establish a cause. In most cases the cause may be unknown but there are certain conditions such as thyroid imbalance, rheumatoid arthritis, diabetes that can precipitate the onset of carpal tunnel syndrome. Pregnancy is another condition which by virtue of fluid retention and swelling in the region of the wrist, can result in symptoms of a carpal tunnel. Obviously, the first thing to treat is the cause, if present. The use of a wrist splint to keep the hand in a neutral position especially when the patient is sleeping or when using their hands in repetitive movement, is mandatory. The use of a natural remedy such as pyridoxine or vitamin B6 in large dosages is often very helpful.

At times it is necessary to inject the carpal tunnel with an anti-inflammatory steroid preparation. Finally, if the symptoms persist, most importantly, not after waiting too long so that the symptoms become irreversible, carpal tunnel surgery where the carpal tunnel is cleaned out is the treatment of choice. If this is diagnosed early this is a very curable disorder.

Author: Norman B. Gaylis, MD, FACP, FACR

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