Carpal Tunnel Syndrome

Harry FischerCourtney Pennill

CTS

Carpal tunnel syndrome is pressure on the median nerve which is the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.

Anatomy

The Actual “ Carpal Tunnel “ is the space under the transverse carpal ligament, heavy band of fibers which runs between hamate & pisiform medially to scaphoid and trapezium laterally, and forms fibrous sheath which contains carpal tunnel

The tunnel is bordered by carpal bones, and transports median nerves & finger flexor tendons from forearm to hand.

It is deep to Palmaris Longus

Causes of CTS

Any condition that exerts pressure on the median nerve at the wrist can cause carpal tunnel syndrome.

Common conditions include: Obesity Pregnancy Arthritis Tendon inflammation resulting from

repetitive work; Typing

Symptoms

Symptoms include the loss of feeling in fingers or hand or the inability to perform simple hand movements such as holding objects or pinching.

Treatment and Recovery

If your CTS is mild, then 1-2 weeks of home treat will likely relieve your symptoms , which include wearing a wrist brace and taking frequent breaks from repetitive tasks, and using anti-inflammatory drugs.

However, if these treatments do not work, or your CTS is more severe surgery is an option.

Surgery involves cutting the ligament from the roof of the carpal tunnel relieving stress.

Extra Story

This patient presented about a week after carpal tunnel release by another surgeon, complaining of worsening throbbing pain in the hand and pain with any movement of the fingers.

The carpal tunnel was found to be filled with pus from a staph aureus deep wound infection.

Infection spread into the forearm through the flexor tendon compartments and deep to them in the retroflexor space (Parona's space) as well as up into the small finger flexor tendon sheath. She was treated with repeated radical debridement, intravenous antibiotics and selayed wound closure. Her infection was cured, but she was left with stiffness of the small finger.