Carpal Tunnel Syndrome
Einstein Health Glossary
ICD 10 - G56.0
What is it?
It occurs when the median nerve is compressed within the tunnel — this can happen in any situation that reduces the size of the tunnel or increases the volume of the tissues passing through it
"Carpus" in Greek means wrist. We have a true "tunnel" in the wrist region: a kind of conduit through which the median nerve passes along with the tendons that flex the fingers and wrist. The median nerve controls the sensation in the palm side of the fingers (except the little finger) and also sends impulses to the muscles that move the thumb
Incidence
It is estimated that the incidence in the general population ranges from 3% to 10%, being more common in women between the ages of 40 and 60. However, with the widespread use of computers, it has also been found in young adults of both sexes
Causes
When we spend a long time with the wrist bent, the space for the nerve is reduced. This happens in situations such as using a tablet or cellphone, driving, or sleeping with the wrist flexed
Risk Factors
- Menopause (due to hormonal changes)
- Pregnancy (fluid retention in the tendons)
- Polycystic ovary syndrome / Endometriosis
- Poor posture
- Diabetes
- Osteoarthritis
- Rheumatoid arthritis
- Hypothyroidism
- Post-wrist fracture
- Repetitive movements / use of computer or cellphone
Symptoms
- One of the classic symptoms is nighttime tingling, where the patient wakes up in the middle of the night with a tingling hand
- Pain complaints vary and may radiate from the fingers to the shoulder, accompanied by a feeling of heaviness or fatigue in the forearm
- A shock-like sensation when touching the wrist near the tunnel entrance indicates that the nerve is under stress
- Over time, the patient may experience a loss of sensation in the fingertips (except the little finger), and in more severe cases, atrophy of the muscles at the base of the thumb, leading to weakened grip and dropping objects
- In about 50% of cases, both sides may be affected
Early diagnosis and treatment are important to prevent permanent nerve damage and resulting numbness and hand atrophy
A medical evaluation is necessary to rule out other conditions that may mimic the symptoms, such as nerve compression in other areas (e.g., a herniated disc) or certain nerve-specific diseases
Treatment
Treatment varies according to the severity of the condition. It usually starts with the use of a splint to immobilize the wrist and prevent flexion, especially at night, combined with hand therapy to manage pain, stretch muscles, correct posture, and strengthen muscles
In selected cases, an injection may be attempted to reduce pressure on the nerve
In resistant or severe compression cases, surgery is required to relieve the nerve. This surgery involves “opening” the roof of the tunnel to release the compressed nerve