Presentation:

The patient present with a complaint of pain and numbness/tingling in the palm side of hand, usually more towards the thumb and the first and middle fingers. Symptoms may be worse at night, and there may be weakness in grip strength.

Cause:

The median nerve runs through an osteofibrous tunnel created by the transverse carpal ligament and carpal bones. Although direct compression from ganglions, fractures and dislocations are possible, it is more common to have a history of direct external pressure on the tunnel or a history of prolonged wrist use in full flexion or extension. Pressure inside the tunnel increases in these extreme positions. Additional factors may have to do with fluid retention, as in pregnancy, rheumatoid arthritis, diabetes, and connective tissue disorders. Patients may also be deficient in B Vitamins.

Evaluation:

Some simple tests can be done at home to determine if carpal tunnel syndrome causing your hand and finger pain.

 

 

Treatment:

Treatment in our office would first determine if the hand and finger pain is truely a carpal tunnel syndrome, or pain being referred from other areas such as the elbow or neck.

With true carpal tunnel syndrome (CTS) we would recommend rest by avoiding the activties that caused the CTS. We would recommend a B-complex vitamin to rule-out vitamins defeciencies.

Ultrasound therapy to the carpal tunnel would reduce inflammation around the median nerve.

Manipulation to the lunate bone of the wrist is one of the most effective treatments for reducing pressure on the carpal tunnel.

Manipulation and mobilization to the other joints of the hand / wrist / forearm are also benificial.

When conservative treatments are not responsive, surgical release of the retinaculum may be necessary. It is important to note that one study indicated that 5 years following surgery, 30% of patients rated their satisfaction as poor or fair. (JAMA. 1991; 265:1922-1925)