Carpal Tunnel Syndrome

The following discussion is for general informational purposes only and is not meant to provide the reader with specific medical advice. Please consult with your personal physician, or with a neurologist, for specific advice, guidance and information regarding your particular circumstances.


Carpal tunnel syndrome is the most common entrapment neuropathy. The term "entrapment neuropathy" refers to compression of a nerve somewhere in its course after it has left the spinal cord.

The term "carpal" means wrist. If one looks at a cross section of the wrist, a tunnel in the very center is apparent. The floor of the tunnel is formed by the wrist bones, which are arranged in two U-shaped rows, one in front of the other. The roof of the tunnel is made from a fibrous band called the flexor retinaculum. Within the tunnel are ten important structures. Nine of these are flexor tendons-made of tough and incompressible material. These are attached to the fingers and serve in the act of flexion, or making a fist. Each finger has two tendons (one for each joint) and the thumb has one (one joint). The tenth structure in the tunnel is a nerve, called the median nerve. The nerve is soft and pliable, and may be compared to a boiled spaghetti noodle. As such it is easily compressible and readily injured.

The tunnel is very tightly packed and conditions may arise in which the structures inside it become pressurized and more tightly compacted. This may be associated, for example, with bony overgrowth due to arthritis or fluid accumulation within the tunnel. When this occurs, the nerve is the most vulnerable structure. Compression of the median nerve in this fashion is called carpal tunnel syndrome (CTS).


Symptoms of carpal tunnel syndrome include tingling or numbness most typically seen in the thumb, index, and middle fingers, and sometimes the half of the ring finger on the thumb side. People with CTS frequently awaken at night with intense pain and numbness in these fingers, which may not be relieved until they get up and shake their hands. Pain in the vicinity of the wrist is not unusual but need not be present. Weakness or clumsiness of the hand is also common, and patients may complain that they drop things or have trouble with activities such as opening jars or buttoning buttons.


Your doctor can diagnose CTS by taking a careful history and performing a neurological examination. The examination may include an electrodiagnostic study called an electromyogram, or EMG. The EMG permits the definitive diagnosis of CTS and also allows the physician to objectively measure whether it is mild, moderate or severe.


There are a number of treatment options which can be discussed with your neurologist once your diagnosis is established. Treatments include periodic use of over the counter anti-inflammatory medications and wrist splints. In the case of severe CTS, you may need to be referred to a surgeon for more aggressive intervention.