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Anatomy Of The Carpal Tunnel

The carpal tunnel is literally that: a tunnel. It is a narrow passageway running from the base of the hand’s palm to just above the wrist. The “walls” of the carpal tunnel are formed by wrist and hand bones, and “the roof” is a ligament that runs lengthwise across the wrist known as the transverse carpal ligament.

See Soft Tissues of the Wrist

The median nerve starts around the shoulder in a cluster of nerve roots and branches known as the brachial plexus. It then passes into the bottom of the upper arm, inside the elbow and forearm, through the carpal tunnel, and finally into the thumb, the index finger, the middle finger, and the side of the ring finger adjacent to the middle finger.

Complications Of Carpal Tunnel Syndrome

Without proper treatment, carpal tunnel syndrome can make daily activities very tough, such as:

  • Buttoning clothing
  • Holding everyday items like a coffee cup
  • Typing
  • Writing

It can lead to a feeling of clumsiness. As the syndrome intensifies, there may be some visual deformities around the wrist tendons.

Carpal Tunnel Syndrome: In Brief

Carpal Tunnel Syndrome is the outcome of the pressure on the nerve in the wrist.1 With this, the median nerve that supplies much of the feeling to a hand is impacted. The most frequent causes of carpal tunnel syndrome are repetitive hand and wrist motions and thus this condition is most often considered as a repetitive stress injury or RSI. Moreover, carpal tunnel syndrome can also be caused by medical conditions like arthritis or lupus. The numbness, burning, tingling, pain and weakness in the hands can seriously impact one’s ability to function.

Carpal Tunnel Syndrome is more commonly seen in women than men and also in the middle-aged and elderly people than in children or youth ones. However it could affect anyone at any time. Other risk factors of Carpal tunnel syndrome include wrist injury, pregnancy, family history of Carpal tunnel syndrome, repeated use of percussive or vibrating tools, health conditions like , , an underactive thyroid gland etc.

Symptoms like numbness, pain or aching in the hand tends to develop gradually and are often initially worse during night. At times, the ache may also develop up to the arm, shoulder and neck. Carpal tunnel syndrome make it really difficult to grip or grasp objects and perform specific tasks like fastening buttons which can really affects an individual’s ability to work.

Left Untreated Carpal Tunnel Syndrome Can Lead To Weakness In Fingers And Thumb

November 30, 2012

Dear Mayo Clinic:

I’ve had symptoms of carpal tunnel syndrome for nearly a year, and it is starting to affect my work. How effective is treatment? What are the risks of not treating it? Will it continue to get worse, or does the damage level off at some point?


Carpal tunnel syndrome is a condition that affects your hand and is caused by pressure on the median nerve in your wrist. If left untreated, carpal tunnel syndrome can lead to weakness and lack of coordination in your fingers and thumb. Treatment can relieve pressure on the nerve and, for most people, eliminate their symptoms.

The carpal tunnel is a small passageway on the palm side of your wrist. Nine tendons and the median nerve travel through the carpal tunnel. The tendons control the movement of your fingers. The median nerve serves as a pathway for the sensations you feel in your palm, thumb, index finger, middle finger and outer border of your ring finger. It also sends nerve signals that move muscles around the base of your thumb.

Carpal tunnel syndrome happens when the space in the carpal tunnel becomes smaller, resulting in pressure on the median nerve. In its early stages, symptoms may include intermittent tingling or numbness in your thumb, index finger, middle finger and outer border of your ring finger, along with aching in the palm. Many people wake up during the night due to numbness and tingling and have to shake the hand to ease those symptoms.

How Is Carpal Tunnel Syndrome Diagnosed

Carpal Tunnel Syndrome: Should I See a Brooklyn Workers ...

Your doctor will ask if you have any health problems—such as arthritis, hypothyroidism, or diabetes—or if you are pregnant. He or she will ask if you recently hurt your wrist, arm, or neck. Your doctor will want to know about your daily routine and any recent activities that could have hurt your wrist.

During the exam, your doctor will check the feeling, strength, and appearance of your neck, shoulders, arms, wrists, and hands. Your doctor may suggest tests, such as blood tests or nerve tests.

When To Use Carpal Tunnel Remedies

The old expression,”There’s no time like the present”directly applies to using the right carpal tunnel remediesNOW.In other words, you shouldneverwait until symptoms get to be “bad enough to do something”.

All too often patients tell me,“I should have paid attention to it a year ago.”A laid-back attitude toward theirearly symptomsis why I get a lot of patients now, at thesevere stage,with crushing pain or punishing numbness.

Regarding when to treat, here are 2 amazing factsabout carpal tunnel syndromeyou should know:


  • When you first feel symptoms, you can almostalwayseliminate them with simple remedies.
  • If you ignore those early symptoms, they will almostalwaysprogress & worsen.
  • How Is It Diagnosed

    The orthopedic surgeons at MedStar Orthopaedic Institute are experts at diagnosing carpal tunnel syndrome. Our initial exam serves to rule out other possible causes of your pain and determine the best relief options. Our team will generally perform the following during your exam:

    • Medical historyevaluation– This includes asking questions about when your pain began and where the pain feels most severe. Other questions may be about whether you have other medical problems, and if you take any medications.
    • Physical exam– Your orthopedist will carefully examine your hand and press the affected nerve to test your response.
    • Electrophysiological tests– Your doctor can confirm a diagnosis by sending small electric shocks into the affected area to see how the nerve responds.
    • Imaging tests – In some cases, your orthopedist may want to examine the bones in your wrist more carefully using X-rays.

    Why Might I Need Carpal Tunnel Surgery

    A diagnosis of carpal tunnel syndrome is about the only reason to have a carpal tunnel surgery. And even then, your doctor will likely want you to try nonsurgical treatments first. These may include over-the-counter pain medicines, physical therapy, changes to the equipment you use at work, wrist splints, or shots of steroids in the wrist to help relieve swelling and pain.

    The reasons that a doctor would recommend a carpal tunnel release surgery may include:

    • The nonsurgical interventions for carpal tunnel syndrome don’t relieve the pain.
    • The doctor performs an electromyography test of the median nerve and determines that you have carpal tunnel syndrome.
    • The muscles of the hands or wrists are weak and actually getting smaller because of the severe pinching of the median nerve.
    • The symptoms of carpal tunnel syndrome have lasted 6 months or longer with no relief.

    Diagnosis Of Carpal Tunnel Syndrome

    When you visit Dignity Health, an orthopedic doctor will review your medical history and examine your hands, wrists, and arms for signs of carpal tunnel. One common test looks for something called “Tinel sign.” Your doctor will tap or press on the median nerve in your wrist and watch for numbness or tingling in your fingertips.

    Your doctor may also ask you to close your eyes and then lightly touch your fingertips with an instrument. This exercise tests your sensation and checks your grip strength and the strength of the muscles around the thumb.

    The physical exam will help your doctor confirm the severity and rule out related conditions, such as arthritis. Diagnostic tests like x-ray, electromyography , and nerve conduction studies may also be used to help your doctor make a diagnosis.

    Are You Wondering If The Pain In Your Shoulder Is From Carpal Tunnel Syndrome

    Carpal tunnel syndrome starts in the wrist and involves a compression of the median nerve. 

    “Carpal tunnel syndrome cannot cause shoulder pain per se,” says Jonathan Oheb, MD, North Valley Orthopedic Institute, Chief of Orthopedic Hand and Upper Extremity Surgery.

    However, one can often get symptoms of referred pain up the arm from median nerve compression distally at the wrist.

    “This is not common but can sometimes present as a patient complaint.”

    “Referred” pain means that the sensation of the pain is in an area other than the source of the pain.

    There is nothing in that actual area that is causing the discomfort.

    An example of referred pain is a pinched nerve in the neck causing a headache behind the eye.

    There is nothing wrong with the structures behind the eye in such a case; the origin of the pain is the compressed nerve in the neck.

    So in carpal tunnel syndrome, likewise, the origin of the problem is in the wrist, but in uncommon cases, the patient can get a referral pain in the shoulder.

    In addition to hand, elbow and shoulder care, Dr. Oheb provides comprehensive surgical and nonsurgical treatment for all orthopedic conditions of the hip, knee and ankle, including broken bones and injuries.
    Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health. 

    What Causes Carpal Tunnel Syndrome

    Pressure on the median nerve causes carpal tunnel syndrome. This pressure can come from swelling or anything that makes the carpal tunnel smaller. Many things can cause this swelling, including:

    • Illnesses such as , rheumatoid arthritis, and .
    • Making the same hand movements over and over, especially if the wrist is bent down , or making the same wrist movements over and over.
    • Pregnancy.

    What If These Treatments Dont Help

    In some cases, surgery is needed to make the symptoms go away completely. The surgery involves cutting the ligament that may be pressing on your median nerve. You’ll usually get back the normal use of your wrist and hand within a few weeks to a few months after surgery.

    Doing the hand, wrist, and finger exercises that your doctor tells you to do after surgery is very important. Without exercise, your wrist may get stiff, and you may lose some use of your hand.

    What Are The Warning Signs Of Carpal Tunnel Syndrome

    Easily Relieve Carpal Tunnel Syndrome

    The early symptoms of carpal tunnel syndrome can vary, but there are a couple that tend to occur first:

    • Reoccurring numbness or pain in your thumb, index finger, and middle finger
    • A sensation of swelling in those fingers
    • Awakening with a need to shake out your hands or wrists in order to relieve pain or tingling—known as the “flick sign”

    Carpal Tunnel Syndrome In Adults

    NYU Langone physicians and therapists work together to customize treatment for carpal tunnel syndrome, a condition that causes pain, weakness, or numbness in the hand and wrist. This occurs when the median nerve, which runs from the arm to the palm, is compressed or squeezed in the carpal tunnel, which is a narrow passageway at the base of the hand. The goal is to minimize pain and help you return to your usual activities as soon as possible.

    Damage to the median nerve can be prevented if carpal tunnel syndrome is diagnosed and treated early. NYU Langone specialists use their extensive experience and expertise to determine the extent of the condition, which enables them to offer you the most effective treatment options.

    Can Carpal Tunnel Syndrome Be Prevented Or Avoided

    You can take steps to prevent carpal tunnel syndrome. The following actions may help to prevent it:

    • Lose weight if you’re overweight.
    • Get treatment for any disease you have that may cause carpal tunnel syndrome.
    • If you do the same tasks over and over with your hands, try not to bend, extend, or twist your hands for long periods of time.
    • Don’t work with your arms too close or too far from your body.
    • Don’t rest your wrists on hard surfaces for long periods of time.
    • Switch hands during work tasks.
    • Make sure the tools you use aren’t too big for your hands.
    • Take regular breaks from repeated hand movements to give your hands and wrists time to rest.
    • If you use a keyboard a lot, adjust the height of your chair so that your forearms are level with your keyboard, and you don’t have to flex your wrists to type.

    Many products you can buy, such as wrist rests for a computer keyboard, are supposed to ease symptoms of carpal tunnel syndrome. No one has proven that these products really prevent wrist problems. Some people may have less pain and numbness after using these products, but other people may have increased pain and numbness.

    How Is It Treated

    Mild symptoms usually can be treated with home care. You can:

    • Stop activities that cause numbness and pain. Rest your wrist longer between activities.
    • Ice your wrist for 10 to 15 minutes 1 or 2 times an hour.
    • Talk to your doctor about trying nonsteroidal anti-inflammatory drugs . They can help relieve pain and reduce swelling. Be safe with medicines. Read and follow all instructions on the label.
    • Wear a wrist splint at night. This takes pressure off your median nerve.

    The sooner you start treatment, the better your chances of stopping symptoms and preventing long-term damage to the nerve.

    You also may need medicine for carpal tunnel syndrome or for a health problem that made you likely to get carpal tunnel syndrome.

    Surgery is an option. But it’s usually used only when symptoms are so bad that you can’t work or do other things even after several weeks to months of other treatment.

    Who Gets Carpal Tunnel Syndrome

    Carpal tunnel syndrome is commonly regarded as anoccupational disorder.That means a person’sis the likely culprit in causing the hand injury.

    Essentially, your job dictates how you use your hands. If it involves a lot of forceful and repetitive movements, especially rapid grip-and-release activity, then you’re at high risk for getting carpal tunnel syndrome.

    We also know fromnumerous medical studiesthat people who spend a lot of time using a mouse andare likely to suffer from carpal tunnel. Also at risk are workers in occupations like:

    As a general rule, if you make multiple and forceful hand movements for more than 6 hours a day, you’re nearly 4 times more likely to get this disorder.Read below for the steps to stop carpal tunnel before it worsens.

    How Carpal Tunnel Syndrome Is Diagnosed

    If you have carpal tunnel syndrome , then you may understand how the symptoms can affect your everyday work and recreational activities. The pain, tingling, and weakness in your hand or fingers may keep you from typing on your computer, writing, or holding items. And one of the most challenging characteristics of carpal tunnel syndrome: getting an accurate diagnosis.

    Getting an accurate diagnosis of your hand pain and tingling can ensure that you get the proper treatment for your specific condition. So how is carpal tunnel syndrome diagnosed, and how do you know that the diagnosis you get is the right one?

    What Is Carpal Tunnel

    Carpal tunnel syndrome is a wrist condition where the median nerve is exposed to increase pressure, causing a numbing, painful sensation. The median nerve runs from the forearm to the hand into an area called the carpal tunnel. It is here that the nerve is exposed to pressure which causes carpal tunnel syndrome.

    What Is Carpal Tunnel Syndrome

    A Carpal tunnel is a narrow passage in the wrist surrounded by bones and ligaments on the palmar side of your hand where a nerve that supplies two-thirds of the hand passes through this tunnel. Due to the anatomy of the tunnel and the superficial location of the nerve, the median nerve is susceptible to swelling due to pressure or compression. When the median nerve is compressed, symptoms are numbness, tingling and in the hand, especially the thumb, index finger, middle finger and half of the ring finger.

    The most common professions where we see carpal tunnel syndrome are the ones where there is repeated flexing and extending of the wrists as seen in cashiers, hairdressers, knitters or even bakers . Constant typing on laptops without proper arm support may also predispose you to carpal tunnel syndrome.

    Other causes of carpal tunnel syndrome are:

    Determine Your Insurance Benefit

    Carpal tunnel anatomical vector illustration diagram ...

    Your insurance coverage is a practical matter. To receive the most insurance benefits and pay the least out-of-pocket for your surgery, you need to choose a surgeon that participates in your plan. 

    But keep in mind, just because a doctor participates in your insurance plan doesn’t mean he or she is a high-quality doctor. You still need to consider the doctor’s experience and expertise.

    Carpal Tunnel Syndrome Treatment

    If carpal tunnel syndrome is caused by a medical problem , your doctor should treat that problem first. Your doctor may ask you to rest your wrist or change how you use your hand. He or she may also ask you to wear a splint on your wrist. The splint keeps your wrist from moving but lets your hand do most of what it normally does. A splint can help ease the pain of carpal tunnel syndrome, especially at night.

    Putting ice on your wrist to reduce swelling, massaging the area, and doing stretching exercises may also help. An over-the-counter non-steroidal anti-inflammatory drug can relieve swelling and pain. These medicines include aspirin, ibuprofen , and naproxen . In more severe cases, your doctor might inject your wrist with a corticosteroid, which reduces inflammation and pain.

    The Carpal Tunnel Syndrome Causes You Ought To Find Out

    A 2008 National Institutes of Health journal article, “Attributable Risk of Carpal Tunnel Syndrome” analyzed and found out the common risks carpal tunnel syndrome, which is a repetitive injury with strain happened due to the compression of a nerve at the palm’s base, has primarily affected laborers and those in construction, manufacturing, and personal service industries. Despite the fact that CTS can happen at any age group, it has historically been most prevalent among people aged 44 and older.

    However, experienced carpal tunnel surgeons have something else to say in these regard. Technology and smartphones, on the other hand, are impacting various fields of occupations and, perhaps young groups which is quite surprising.

    According to NPR’s “Typing, Texting, and Carpal Tunnel” report, Americans spend countless hours spending on laptop and mobile.

    In addition to numbness and tingling, gripping pain, and clumsiness when handling objects, carpal tunnel syndrome can cause a number of symptoms. Carpal tunnel syndrome can affect the elbow and shoulder in addition to the hand.

    As of yet, there is no way to prevent carpal tunnel syndrome, but precautionary measures can be taken to reduce the risk. These measures for prevention are helpful if your work ambience involves a lot of smartphone and laptop usage:

    The colder the environment, the more likely it is that your hands, fingers, and wrists will become painful and stiff.

    This Is Where You Can Seek Help

    What Happens After Carpal Tunnel Surgery

    Your wrist will likely be in a heavy bandage or a splint for 1 to 2 weeks. Doctors usually schedule another appointment to remove the bandage or splint. During this time, you may be encouraged to move your fingers to help prevent stiffness.

    You’ll probably have pain in your hand and wrist after surgery. It’s usually controlled with pain medicines taken by mouth. The surgeon may also have you keep the affected hand elevated while sleeping at night to help decrease swelling.

    Once the splint is removed, you will likely begin a physical therapy program. The physical therapist will teach you motion exercises to improve the movement of your wrist and hand. These exercises will speed healing and strengthen the area. You may still need to sometimes use a splint or brace for a month or so after surgery.

    The recovery period can take anywhere from a few days to a few months. In the meantime, you may need to adjust job duties or even take time off from work while you heal. Your doctor will talk to you about activity restrictions you should follow after surgery.

    Let your doctor know about any of the following:

    • Fever
    • Redness, swelling, bleeding, or other drainage from the incision
    • Increased pain around the incision

    These problems may need to be treated. Talk to your doctor about what you should expect and what problems mean you need to see your doctor right away.

    Purpose Of Carpal Tunnel Surgery

    The median nerve, which starts at the shoulder and extends down to the tips of the fingers, is one of the major nerves of the upper extremities. This nerve not only directs the contractions of muscles in the forearm and hand but provides sensation to the hands and fingers.

    When the median nerve is compressed in the carpal tunnel—a narrow passageway from the wrist to the hand that’s made of tendons, ligaments, and bones—symptoms of carpal tunnel syndrome can develop and, over time, become .???

    Carpal tunnel surgery is generally indicated when you fail to respond to conservative therapies after more than six months.?????

    From a physiological standpoint, surgery should be pursued if carpal tunnel syndrome manifests with the following features:

    • Severe chronic pain
    • Inability to place the thumb in a perpendicular position
    • Loss of finger dexterity
    • Loss of protective sensation in the fingers and hand
    • Loss of two-point discrimination, the ability to discern two separate objects touching the skin at the same time??

    Carpal Tunnel Syndrome Doctor Discussion Guide

    Get our printable guide for your next doctor’s appointment to help you ask the right questions.

    How Can A Doctor Help Me With My Carpal Tunnel Syndrome

    February 25, 2021

    Carpal tunnel syndrome causes symptoms such as pain, numbness, tingling, and weakness in the hand due to compression of the median nerve in the carpal tunnel. The median nerve runs through a tunnel in the wrist, and this nerve is what provides sensory and motor functions in the hand – including all fingers except the pinky.

    Compression of the median nerve can affect the use of your hand, and it can develop into permanent disability if left untreated. Fortunately, carpal tunnel syndrome is one of the most common conditions orthopedic surgeons treat. Let’s talk about what your doctor can do for your carpal tunnel syndrome, and where you can go for a medical evaluation and treatment for your hand pain.

    About Carpal Tunnel Syndrome

    Carpal tunnel syndrome is a common condition that causes numbness, tingling, pain, or weakness in your wrist or hand, particularly in your thumb and first few fingers. Repetitive motions — such as assembly line work, racquet sports, and typing — are often the cause. 

    What Causes Carpal Tunnel SyndromeThe carpal tunnel is a narrow passageway in your wrist where nerves and tendons pass through to your hand. If your tendons or tissues become swollen, they can compress a nerve, causing carpal tunnel syndrome. You’re more likely to get the condition if you have relatively small carpal tunnels. It can also occur due to a traumatic injury or following surgery.

    When to Seek Treatment for Carpal Tunnel SyndromeRest, applying cold packs, and avoiding repetitive motion can help, but if your symptoms persist or interrupt your sleep or daily activities, it may be time to see a hand and wrist specialist. It’s important not to wait too long to get care; carpal tunnel syndrome can lead to permanent nerve damage if left untreated.

    Our hand and wrist specialists see patients at Duke Orthopaedic clinics throughout the Triangle. Find one near you. In-person and virtual appointments are available.

    Can Carpal Tunnel Syndrome Cause Pain In The Armpit

    June 19, 2010 by Kathryn Merrow

    Can your Carpal Tunnel Syndrome cause pain in your armpit?  Here’s a switch; I mean really a switch. 

    Your wrist and hand symptoms can be caused by the muscles under your arm.  Under your armpit you have muscles that attach from ribs to arm and shoulder.  You have muscles in your chest that also attach to your arm.

    When these muscles get tight, they can traction down on the nerves that pass through your arm to your hand.  The nerves hate being pressed on and so they cause discomfort in your hand.

    Although short muscles don’t usually complain, the ones under your armpit can be

    uncomfortable when they are in a “knot” or spasm.

    The muscles on the side of your back, just behind your armpit, can also be involved .  Those muscles can also have pain when they are in spasm or contraction.

    So, you see, this is NOT a case of which comes first–the chicken or the egg. 

    Even if you were not aware of the armpit pain before your hand pain started, the spasm was most likely already there.  It is just becoming tighter with time.

    It is very likely that our carpal tunnel pain is a result of that tightness in the muscles under your armpit.

    The good news is that you can press into those armpit muscles by yourself.  It will be uncomfortable because they are tight.  Just keep pressing and feeling and assessing the tightness in those muscles.  By pressing into those muscles with your fingers, it mechanically relaxes them.

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