Carpel Tunnel Syndrome

Carpel Tunnel Syndrome overview and Definition

       Carpel Tunnel syndrome is a common condition that causes pain, numbness, tingling, and weakness in the hand and wrist. It takes place when there is increased pressure within the wrist on a nerve called the median nerve. This nerve provides sensation to the thumb, index, and middle fingers, and to half of the ring finger.

Structure of Carpel Tunnel Syndrome

The carpal tunnel is a narrow canal or tube in the wrist. Similarly to a tunnel you could travel through by car, this part of the wrist allows the median nerve and tendons to connect the hand and forearm. The parts of this tunnel include:

  • Carpal bones: These bones make up the bottom and sides of the tunnel. They are formed in a semi-circle.
  • Ligament: The top of the tunnel, the ligament is a strong tissue that holds the tunnel together.

Inside the tunnel are the median nerve and tendons.

  • Median nerve: This nerve provides feeling to most of the fingers in the hand (expect the little finger). It also adds strength to the base of the thumb and index finger.
  • Tendons: Rope-like structures, tendons connect muscles in the forearm to the bones in the hand. They allow the fingers and thumb to bend.


The tendons of the hands are wrapped with a lining that produces a synovial fluid which lubricates the tendon. With repetative movemnets of the hands the lubrication system might malfunction. This reduction in the fluid results in inflammation and swelling of the tendon area. Abnormally high pressure area is created with the carpel tunnel syndrome patients. This pressure causes obstruction to venous outflow, back pressure, edema formation and ultimately ischemia to the nerve.

Clinical signs & symptoms





Patient often awake to shake their hand to provide the relief to the symptoms and this is known as flick sign

Inability to move the wrist and hands

Weakness and clumsiness in the hand—this may make it difficult to perform fine movements such as buttoning your clothes

Dropping things—due to weakness, numbness, or a loss of proprioception


Differential Diagnosis

                 The doctor might do physical evaluation and find out the diagnosis.

The physician might carefully examine your hand and wrist and perform a number of physical test:

  • Press down or tap along the median nerve at inside of your wrist to see if it causes any numbness or tingling in your fingers (Tinel sign)
  • Bend and hold your wrists in a flexed position to test for numbness or tingling in your hands
  • By lightly touching the wrist and hand with a special instrument when your eyes are closed and examining the sensitization of the hand.
  • Check for weakness in the muscles around the base of your thumb
  • Look for atrophy or shortness in the muscles around the base of your thumb. In severe cases, these muscles may become visibly smaller.


Electrophysiological tests:

The doctor might check for the median nerve damage and examine the thumb finger.

 Have another nerve condition, such as neuropathy, or other sites of nerve compression that might be contributing to your symptoms.


Electrophysiological tests may include:

  • Nerve conduction studies. These tests measure the impulses transmitted to the nerves of your hand and arm and can detect when a nerve is not conducting its signal effectively. Nerve conduction studies can help your doctor determine how severe your problem is and help to guide treatment.
  • Electromyogram (EMG). An EMG measures the electrical activity in muscles. EMG results can show whether you have any nerve or muscle damage.


An ultrasound uses high-frequency sound waves to help create pictures of bone and tissue. Your doctor may recommend an ultrasound of your wrist to evaluate the median nerve for signs of compression.


X-rays provide images of dense structures, such as bone. If you have limited wrist motion or wrist pain, your doctor may order x-rays to exclude other causes for your symptoms, such as arthritis, ligament injury, or a fracture.

Magnetic resonance imaging (MRI) scans:

 These studies provide better images of the body's soft tissues. Your doctor may order an MRI to help determine other causes for your symptoms or to look for abnormal tissues that could be impacting the median nerve. An MRI can also help your doctor determine if there are problems with the nerve itself—such as scarring from an injury or tumor.



             The pain might get subside within two to three months. But the complete recovery might take 1 year.


  • Minimize repetitive hand movements.
  • Alternate between activities or tasks to reduce the strain on your hands and wrists.
  • Keep wrists straight or in a neutral position.
  • Avoid holding an object the same way for long.
  • If you work in an office, adjust your desk, chair, and keyboard so that your forearms are level with your work surface.
  • Wear a splint at night to keep your wrist straight while sleeping.