Doctor - What can I do about Carpal Tunnel Syndrome?


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Carpal tunnel syndrome occurs when the median nerve, one of the major nerves that provides innervation to the hand, is pinched in the carpal tunnel. The carpal tunnel is a narrow space on the palm side of the wrist. The “floor" of the tunnel is formed by the wrist bones; the roof is created by a tough piece of tissue called the flexor retinaculum. If the carpal tunnel opening becomes constricted for whatever reason, then pressure is exerted on the median nerve. The patient will develop symptoms such as burning, numbness, and tingling in the hand involving mostly the thumb, index, third, and part of the fourth fingers. If the pressure continues without adequate treatment, then the ability to use those fingers to grip will also worsen.

The carpal tunnel can be narrowed as a result of trauma, edema (fluid build-up as occurs during pregnancy), repetitive motion, thyroid disease, acromegaly (growth hormone excess), gout, and various forms of arthritis (rheumatoid arthritis is the most common).

The diagnosis is suspected by taking a careful history. Further corroboration is established through a careful physical examination by a skilled clinician. Nerve conduction tests are also helpful for confirmation.

The initial treatment may consist of splinting as well as anti-inflammatory medications. Rest- staying away from keyboard work if this is what brought it on in the first place – is mandatory.

If symptoms persist, then a corticosteroid injection into the carpal tunnel using ultrasound needle guidance is a good option. Data indicates that this procedure may be very helpful in alleviating the symptoms. Patients who do not respond to injection and splinting are probably candidates for surgery. While most patients may be suitable for endoscopic carpal tunnel release, others may require open release.

Dr. Wei is a board-certified rheumatologist and Clinical Director of the Arthritis and Osteoporosis Center of Maryland ( ). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to:


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