Carpal Tunnel Syndrome

By Carolyn Kisner PT, MS and Lynn Allen Colby PT, MS on February 24th 2009

The carpal tunnel is a confined space between the carpal bones dorsally and the transverse carpal ligament (flexor retinaculum) volarly. In this region the median nerve is susceptible to pressure as it courses through the tunnel with the extrinsic finger flexor tendons on their way into the hand. Carpal tunnel syndrome (CTS) is characterized by the sensory loss and motor weakness that occur when the median nerve is compromised in the carpal tunnel. Anything that decreases the space in the carpal tunnel or causes the contents of the tunnel to enlarge could compress or restrict the mobility of the median nerve, causing a compression or traction injury and neurological symptoms distal to the wrist.

Etiology of Symptoms

Etiologic factors include synovial thickness and scarring in the tendon sheaths (tendinosis) or irritation, inflammation, and swelling (tendinitis) as a result of repetitive or sustained wrist flexion, extension, or gripping activities or sustained pressure. Because of this CTS is frequently classified as a cumulative trauma or overuse syndrome. Swelling of the wrist joint due to trauma to the carpals (e.g., a fall or blow to the wrist), a fracture of the carpals, pregnancy (hormonal changes and water retention), rheumatoid arthritis, or osteoarthritis could decrease the carpal tunnel space. Awkward wrist postures (flexion or extension), compressive forces from sustained equipment usage, and vibration against the carpal tunnel could also lead to median nerve compression and trauma.

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Tags: CTS, etiology, symptoms

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