Carpal Tunnel Syndrome

The wrist is a joint composed of multiple articulations between the forearm bones (radius and ulna) and several carpal bones (hand bones). The wrist is an extremely mobile and adaptable joint of our body that has the important function of allowing fine movements of our hands. Wrist stability is maintained by passive (e.g.: capsule, ligaments, etc.) and active (muscles) stabilisers, which have the function of supporting the joint throughout different movements. The carpal tunnel is a narrow space in which multiple structures such as nerves and tendons pass through to reach the hand. It is delineated by different structures, with the carpal bones constituting the “floor” and the “sides” of the tunnel, and the flexor retinaculum or transverse carpal ligament (generally speaking a thick band of tissue), the “roof”. The carpal tunnel syndrome is defined as an entrapment neuropathy or compression syndrome, in which the median nerve that travels through the carpal tunnel gets compressed. The increased pressure in the carpal tunnel can be broadly classified into two categories, conditions that decrease the size of the tunnel, or pathologies that lead to the augmentation of the contents of the carpal tunnel. Generally, the causes for the development of this condition include genetic predisposition, activities that significantly stressed the wrist through repetitive motion, previous wrist injuries, and other systemic disorders (e.g.: rheumatoid arthritis, cysts, etc.). Patients affected by this condition typically report an insidious onset of their symptoms, that tends to get worse with activity and slightly improve at rest. Patients can report pain, neural symptoms (e.g.: tingling, numbness, weakness, etc.) to the hand, and impacted arm-hand functioning. Aside from collecting data from the injury mechanisms and performing a physical assessment of the patient, an imaging examination (e.g.: ultrasound, MRI) is typically performed to optimally visualise the specifics of the condition.