The carpal tunnel is a narrow passageway located on the palm side of your wrist. Bound by bones and a ligament, the tunnel protects one of the important nerves to your hand (the median nerve) and the tendons that bend your fingers.

Carpal tunnel syndrome is a painful, progressive condition that occurs when the median nerve is under more pressure than it likes -- knows as a compressive neuropathy.

What causes carpal tunnel syndrome?

Carpal tunnel syndrome is a compressive neuropathy of the median nerve at the wrist -- where the nerve is under more pressure than is healthy for it, resulting in diminished blood supply and nerve dysfunction.

Carpal tunnel syndrome often is the result of many factors, all of which increase pressure on the nerve at the level of the wrist.

Common contributing factors include:

Trauma or injury to the wrist that causes swelling
Hyperactive thyroid
Rheumatoid arthritis
Mechanical problems in the wrist joint
Repeated use of vibrating hand tools
Fluid retention during pregnancy or menopause

What does it feel like?

Symptoms typically start gradually, including one or more of the following symptoms which affect (usually) the thumb, index, long and sometimes the ring finger: numbness, burning, pain, aching, itching, tingling.

Decreased grip strength may make it difficult to form a fist, grasp small objects, write, or perform other daily tasks.

Some patients report dropping things more frequently and note pain or numbness that awakens them from sleep.

In severe or untreated cases, the muscles at the base of the thumb may deteriorate and some people may not be able to tell between hot and cold by touch.

How do I know if I have carpal tunnel syndrome?

Early diagnosis is important so that permanent damage to the median nerve is prevented. A physical examination will focus on hands, arms, shoulders, and neck.

Routine laboratory tests and x-rays can help rule out diabetes, arthritis, fractures, and other conditions which involve symptoms similar to those of carpal tunnel syndrome.

How is carpal tunnel syndrome treated?

Treatment for carpal tunnel syndrome should begin as soon as possible to prevent nerve damage.

Medicine may be prescribed to manage the pain, and a splint may be beneficial to minimize positioning of the wrist in flexion or extension, both of which put additional pressure on the nerve. A cortisone injection has been demonstrated to be beneficial in certain stages of the condition.

Surgery may be recommended if symptoms do not improve.

Surgery involves a small incision at the wrist in order to divide the roof of the carpal tunnel -- a ligament -- allowing the tunnel to increase in volume by about 25 percent. This is the best way to give the nerve “more room” and reduce pressure on the nerve.

Typically, surgery is done as an out-patient procedure. Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take several months.

Duke Orthopaedics treats carpal tunnel syndrome at locations throughout North Carolina, including Raleigh, Durham, and Chapel Hill.

Learn more about Duke's treatment programs.

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