The median nerve runs down the palm side of the wrist in a compartment called the carpal tunnel (made of ligaments and other structures).
When structures in the carpal tunnel compress (push against) the median nerve, it causes pain and other symptoms. This is known as carpal tunnel syndrome. The most common cause is repetitive hand movement, such as working at a computer keyboard.
Pain/burning in wrist or hand
Pain may radiate to forearm or shoulder
Activity with hand or wrist makes pain worse
Synovitis (inflammation of tendons or ligaments of the carpal tunnel) is usually due to repetitive motion of fingers, hands, or wrist. This is the most common cause.
Bone fractures
Tumors
Genetic abnormalities
Arthritis
Sarcoid
Acromegaly
Hyperparathyroidism
Hypocalcemia
Diabetes
Examination:
Tinel's sign -- tingling or shock pain when the area below the wrist is tapped
Phalen's sign -- pain or loss of sensation when both wrists are completely bent for 60 seconds
Muscle weakness and/or loss of muscle mass in muscles of hand
Tests:
- Electromyography (EMG) and nerve conduction test
Avoidance of, or rest from, the triggering activity (e.g., typing)
Splinting of hand and forearm at night
Corticosteroid injections into the carpal tunnel compartment (it decreases inflammation)
Surgery
Treat underlying cause if one exists (e.g., arthritis, tumor).
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