Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is an issue afflicting many people every day, often due to overuse and repetitive movement of the wrist (specifically the flexor muscles). Actions such as typing, massaging and rock climbing are activities known to contribute to this problem. 

CTS is caused by entrapment of the median nerve between the flexor retinaculum (a ligament that acts as a pulley for the flexor tendons) and the carpal bones (the two structures making the tunnel). Both the median nerve and wrist flexors run between those two structures, so when inflammation occurs, and neither the flexor retinaculum nor the carpal bones are able to expand to help relieve pressure, the median nerve is ultimately compressed. 

Patients with CTS will often present with numbness, tingling, weakness and pain extending from the wrist, into the palm of the hand and up into the thumb, pointer, middle and lateral half of the ring finger. If compression is before the tunnel and the palmar branch is affected, patients will experience symptoms in the middle of the palm.  They may also present with the ‘flick maneuver’ to relieve pain which is exactly as it sounds, a flicking of the wrist as though they were trying to get some water off of it. 

Compression of the median nerve can occur in numerous other places and it is important to rule them out before confirming CTS. Compression can occur at the vertebrae as the nerve exits, between the scalene muscles, under the clavicle and between the heads of the pronator teres muscle. 

For more information on Carpal Tunnel Syndrome, the tests to confirm or rule it out, please refer to Professional Health Systems’ Conditions Manual. 

A section of the wrist displaying the carpal bones, flexor tendons, median nerve (black oval) just above the tendons, and the flexor retinaculum running above those structures.