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What is carpal tunnel syndrome?
Do you often feel a numbness or tingling in your hand, especially at night? Maybe you experience clumsiness in handling objects and sometimes you feel a pain that goes up the arm to as high as the shoulder. These may be the symptoms of carpal tunnel syndrome.

The median nerve travels from the forearm into your hand through a "tunnel" in your wrist. The bottom and sides of this tunnel are formed by wrist bones and the top of the tunnel is covered by a strong band of connective tissue called a ligament. This tunnel also contains nine tendons that connect muscles to bones and bend your fingers and thumb. These tendons are covered with a lubricating membrane called synovium which may enlarge and swell under some circumstances. If the swelling is sufficient it may cause the median nerve to be pressed up against this strong ligament which may result in numbness, tingling in your hand, clumsiness or pain described above.

How is it diagnosed?
Your doctor may diagnose this condition by the following symptoms and signs:

• numbness and tingling in the hands, especially when these symptoms occur at night and after use of the hands
• decreased feeling in your thumb, index, and long finger
• the presence in your hand of an electric-like shock or tingling (like hitting your "funny bone") when your doctor taps over the course of the median nerve at the wrist
• the reproduction of your symptoms by holding your wrists in a bent down position for one minute
In some cases your doctor may recommend a special test called a nerve conduction study. This test, done by a specialist, determines the severity of the pressure on the median nerve and may aid your orthopaedic surgeon in making a diagnosis and forming a treatment plan.

How is it treated?
Mild cases may be treated by applying a brace or splint which is usually worn at night and keeps your wrist from bending. Resting your wrist allows the swollen and inflamed synovial membranes to shrink; this relieves the pressure on the nerve. These swollen membranes may also be reduced in size by medications taken by mouth called non-steroidal anti-inflammatories. In more severe cases, your doctor may advise a cortisone injection into the carpal tunnel. This medicine spreads around the swollen synovial membranes surrounding the tendons and shrinks them, and, in turn, relieves the pressure on the median nerve. The dosage of cortisone is small and when used in this manner it usually has no harmful side effects. The effectiveness of non-surgical treatment is often dependent on early diagnosis and treatment.

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