What is Carpal Tunnel Syndrome?

The median nerve is one of the three major nerves in the forearm and wrist. Carpal tunnel syndrome occurs when the median nerve becomes compressed or pinched and becomes inflamed at the level of the wrist. It’s located on the palm side of your hand, providing sensation to the thumb, index finger and middle finger. The median nerve also provides the electrical impulse to the muscle leading to the thumb. Carpal tunnel syndrome can occur in one or both of your hands. 

What are the symptoms of carpal tunnel syndrome?

Aside from causing wrist pain, carpal tunnel syndrome can lead to numbness, weakness, and tingling on the side of your hand near the thumb

What are the risk factors for carpal tunnel syndrome?

Risk factors for carpal tunnel syndrome include: 

  • performing repetitive tasks with your hands, such as typing, drawing, or sewing
  • pregnancy
  • having certain medical conditions, such as diabetes, arthritis, kidney problems, or an underactive thyroid
  • having a family history of carpal tunnel, as anatomic differences can run in families
  • female sex
  • obesity
  • advanced age
  • smoking
  • alcoholism

How is carpal tunnel syndrome diagnosed?

Dr. Kevin Mangum a sports medicine physician will do a thorough history and physical exam.  There are several medical tests that are preformed to help confirm the diagnosis of carpal tunnel syndrome. Thenar atrophy, self administered hand diagram, carpal tunnel compression test (Durkan’s test), Phalen test, Tinel’s test, and Semmes-Weinstein testing are a few of the medical tests that help confirm carpal tunnel syndrome. Nerve conduction velocity (NCV) and electromyography (EMG) studies are also ordered to help confirm the diagnosis of carpal tunnel syndrome. Dr. Kevin Mangum has advanced training in diagnostic musculoskeletal ultrasound. Ultrasound has also been shown to be effective in diagnosing carpal tunnel syndrome.

How is carpal tunnel syndrome treated?

Carpal tunnel syndrome is treated conservatively at first, but if there is no improvement in the symptoms, then other and more advanced techniques are tried. Nonsteroidal anti-inflammatory drugs (NSAIDs), can be very helpful for pain. Using a wrist splint or night splint has been shown to be very helpful for patients with nighttime numbness, tingling and pain in their hands. Reducing and avoiding aggravating activities like a lot of wrist movements and gripping movements, have also been found to be helpful. If the conservative treatments are not helping, then we escalate therapy to corticosteroid injections. Dr. Kevin Mangum is a board-certified sports medicine physician who is trained in diagnostic and therapeutic ultrasound injections. Most of his patients have 90% of improvement with symptoms. If injections do not work, then surgery is recommended.

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References

Yoshii, Yuichi, Chunfeng Zhao, and Peter C. Amadio. “Recent advances in ultrasound diagnosis of carpal tunnel syndrome.” Diagnostics 10.8 (2020): 596.

Azami, Ahad, et al. “The diagnostic value of ultrasound compared with nerve conduction velocity in carpal tunnel syndrome.” International Journal of Rheumatic Diseases 17.6 (2014): 612-620.

Moran, Luz, et al. “Sonographic measurement of cross‐sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies.” Journal of clinical ultrasound 37.3 (2009): 125-131.

Viera, Anthony J. “Management of carpal tunnel syndrome.” American family physician 68.2 (2003): 265-272.

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