The small bones in our wrist form one side of a tunnel and a ligament (or retinaculum to more specific) forms the other side. In this tunnel, called the Carpel Tunnel sit many tendons which are used for gripping and bending the wrist into flexion. The median nerve also sits in this tunnel. There is only a certain amount of space in the tunnel. If the tendons get irritated by overuse they will naturally swell and increase the pressure within the tunnel and compress the median nerve. Other reasons why pressure within the tunnel can increase can be the effects of pregnancy.
Symptoms include burning wrist pain on the palm side with numbness and pins and needles in the distribution of the Median Nerve. That is the thumb, index finger, middle finger and thumb side of the ring finger. Nocturnal pins and needles is common. Pain can radiate to the forearm, elbow and shoulder. Diagnosis is achieved through history taking and holding the wrist in prolonged flexion to reproduce symptoms. Tinsel’s sign can also help reach a diagnosis. This test comprises of repetitively tapping over the wrist on the palm side where the Median Nerve passes to reproduce symptoms.
Mild cases can be treated effectively with anti-inflammatories and physiotherapy. A Physiotherapist will release the tension from the muscles and tendons that flex the wrist and fingers and provide stretches for a patient to do. Additionally a physiotherapist will provide a splint which keeps the wrist in a neutral position for the irritated Median Nerve to settle. For more severe cases simple surgery to create more space in the tunnel can be done.