Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the median nerve gets trapped on the palmar (palm) aspect of the wrist. The median nerve usually travels to the thumb, index, and half of the middle finger. Thus, any “pinching” of the nerve at the wrist gives numbness and tingling in the above distribution. Patients will often describe “my hand going to sleep”. Patients will often describe waking up in the middle of the night with the above-noted symptoms, and even occasionally “hitting their hands against the side of the bed to make the circulation come back”. Similar symptoms can occur with prolonged use of a computer keyboard or heavy road equipment. In vehicle accidents, this area is commonly injured when the wrist hyper-extends or “jams backwards” against the steering wheel. Clinical diagnosis can usually be confirmed by compressing or squeezing the median nerve as it passes through the palmar aspect of the wrist, causing tingling in the above-noted location.

Common forms of treatment include icing the area frequently, taking antiinflammatories by mouth (if not contraindicated), or using a wrist splint that keeps the wrist in a more neutral position. These often can be worn at night only with good symptomatic relief. If the above does not work, the addition of laser therapy is often effective. If surgery is being considered, nerve conduction studies are performed to confirm the diagnosis of the nerve being “trapped at the wrist”. Surgery entails cutting the ligament that runs on the palmar aspect of the wrist, thus “freeing up the median nerve”.

Although this symptom complex is reasonably common in vehicle accidents, it is usually able to be successfully treated with some combination of the above-noted treatment modalities.

A Better Way to Get Better,
Adrian Lewis
Adrian Lewis, MD