Carpal Tunnel Syndrome

People can have a wide variety of carpal tunnel syndrome symptoms, but the condition typically causes hand and wrist pain, weakness in specific muscles of the hand, and abnormal sensations including tingling and numbness in specific areas of the hand supplied by the pinched nerve.

The most common symptoms of carpal tunnel syndrome are:

• Hand and finger pain

• Tingling sensations of the fingers

• Numbness in the fingers

One common symptom of carpal tunnel syndrome is that people find shaking the hand often relieves these symptoms. Pain may extend up the arm, and the pain from carpal tunnel syndrome is often worst at night. Often patients find they are awakened at night, and have to shake out their hand to get the tingling in their fingers to resolve. Other activities including driving and typing can aggravate symptoms of carpal tunnel syndrome.

How is the diagnosis of carpal tunnel syndrome made?
In diagnosing carpal tunnel syndrome, your doctor will look for changes in sensation and for weakness in the muscles controlled by the median nerve. Several simple tests can be done to elicit carpal tunnel syndrome symptoms to diagnose the disorder. Two common tests are called Tinel's and Phalen's Test.

• Tinel's Sign
  Tinel's test is performed by tapping the median nerve along its course in the wrist. A positive test is found when this causes worsening of the tingling in the fingers when the nerve is tapped.

• Phalen's Sign
  Phalen's test is done by pushing the back of your hands together for one minute. This compresses the carpal tunnel and is also positive when it causes the same symptoms you have been experiencing with your carpal tunnel syndrome.

What other tests can be done to make a diagnosis of carpal tunnel syndrome?
Definitive analysis of nerve function can be performed with studies of how well an electric impulse conducts along the nerve. A device called an EMG can detect abnormalities in nerve impulse conduction; these nerve conduction abnormalities are the cause of carpal tunnel syndrome symptoms. The EMG does not always need to be performed, but may be done if a patient's symptoms are not typical of carpal tunnel syndrome.

What causes the carpal tunnel syndrome symptoms?
As stated previously, the symptoms of carpal tunnel syndrome are caused by compression of the median nerve as it courses through the carpal tunnel in the wrist. Some systemic conditions are associated with carpal tunnel syndrome, including diabetes, hypothyroidism, arthritis, and pregnancy.

Recently, the computer keyboard has been the target of blame for many patients with carpal tunnel syndrome. Whether or not typing causes carpal tunnel syndrome is still controversial, yet it seems appropriate that anyone who spends much time at the computer be familiar with techniques in prevention of this problem. Similarly, other activities that depend on wrist motion such as shop work, weight lifting, and racquet sports have been associated with carpal tunnel syndrome. Carpal tunnel syndrome is most common in the middle aged and elderly, with over 80% of patients over 40 years of age.

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