The carpal tunnel is the passageway in the wrist and is made up of the arching carpal bones (eight bones in the wrist) and the ligament connecting the pillars of the arch. The median nerve and the tendons that connect the fingers to the muscles of the forearm pass through the tightly spaced tunnel.

Carpal tunnel syndrome occurs when the nerve becomes compressed due to swelling of the nerve or tendons or both.

Excessive repetitive movements of the arms, wrists or hands can aggravate the carpal tunnel, triggering the symptoms of carpal tunnel syndrome. Untreated, this can become chronic, but when detected early, carpal tunnel syndrome can be treated more easily and recovery is possible in a few months.

Patients with conditions that affect the nerves directly such as rheumatoid arthritis, diabetes or other metabolic conditions, like thyroid disease are often more vulnerable. Pregnancy has also been linked to carpal tunnel syndrome. It usually resolves within a few months after delivery.

DIAGNOSIS
In addition to a clinical exam, further tests to determine the extent of nerve damage may include an electromyogram (EMG) and nerve conduction studies (NCV). An electromyogram is a test that measures the electrical activity in your nerves and muscles. Nerve conduction studies measure the ability of specific nerves to transmit electrical impulses or messages.

"Approximately 70% of the people who come in for their tests at the Neurodiagnostic Lab are being evaluated for Carpal Tunnel Syndrome," says Carmen Placido, Coordinator of the Neurodiagnostic Lab, "The cases we see range anywhere from mild to severe."

SYMPTOMS

• Fingers feel like they are "asleep."
• Numbness and tingling more noticeable at night.
• A burning sensation that can radiate up the forearm sometimes extending to the shoulder.
• In instances of severe carpal tunnel syndrome, symptoms are apparent in the day.

PREVENTION

• Lifestyle changes
• Sleep with your wrists straight or use a splint
• Keep your wrists straight when using tools
• Avoid flexing and extending your wrists repeatedly
• Perform conditioning and stretching exercises
• Use correct positioning of hands and wrists while working
• Change the frequency of repetitive motions (i.e. typing on a keyboard)

MEDICATION
Anti-inflammatory drugs or short-term steroids (in mild to moderate cases) can help to reduce swelling.

SURGERY
This option is effective when conservative methods have been exhausted.

EXERCISE
Helpful At-Home Exercises for flexibility may include:

• Rotating your wrist up, down, and from side to side.
• Stretching your fingers far apart, then relaxing them, then stretching them again.
• Stretching your thumb by pulling it back gently, holding it, and then releasing it.

Exercises to increase strength may include:

• Squeezing a rubber ball
• Wrist curls and extensions with a light weight

WHY GO TO THE CHESTER COUNTY HOSPITAL?
The Neurodiagnostic Lab at the Hospital offers the same diagnostic tests that many practices like to keep "in-house" using their own diagnostic professionals. The advantage of the using the Hospital's services is that it offers both neurologists as well as physiatrists (a healthcare professional who administers physical therapy), which are the only two approved physicians to conduct this testing according to National Guidelines. And, in most cases, lab reports are turned around in less than a 24-hour time period.

LOCATION and CONTACT INFORMATION
The Chester County Hospital
701 East Marshall Street, 2nd Floor
West Chester, PA 19380

Hours: Flexible scheduling - Monday-Friday, 8 am to 4:30 pm

To schedule an appointment: 610.738.2771 (Physician Referrals Required.)
Questions regarding tests: 610.738.2789.

Last Updated: 6/1/2012