Carpel Tunnel Syndrome

Carpal tunnel syndrome (CTS) has long been regarded in the medical community as a “simple problem” and unfortunately there have been very few comprehensive publications in either the medical or the lay literature to clear up some of the misinformation that surrounds carpal tunnel syndrome.

Carpal tunnel syndrome was a term first used in the 1930’s to describe an entrapment neuropathy of the median nerve at the wrist. There is nothing new whatsoever about carpal tunnel syndrome. Human beings have had carpal tunnel syndrome for as long as there have been carpal tunnels. The first open carpal tunnel release was described in 1947 and nothing changed very much for 50 years until the advent of the endoscopic procedure in 1990.
Along about the same time, the media publicized the fact that some individuals involved in repetitive type work activities, such as those who work on computers all day, have an increased incidence of carpal tunnel syndrome. In point of fact, most people who come in the hand surgeon’s office with carpal tunnel syndrome are perplexed as to why they have this disease because they do not engage in classical repetitive type work activities.

Carpal tunnel syndrome is easily understood if one begins with the anatomy. The carpal tunnel is formed by a semi-circle of carpal bones on three sides. The fourth side that forms the carpal tunnel is the transverse carpal ligament. The ligament cannot stretch. Thus the carpal tunnel is a defined space that cannot enlarge. There is only so much room in that opening. Through that opening passes the median nerve, nine tendons, and spongy tissue around the tendons called tenosynovium. We start our lives with that extra space. When we run out of extra space due to the swollen tenosynovium then pressure is placed on the nerve. When this happens, one begins to develop carpal tunnel symptoms.

Classic textbook carpal tunnel syndrome symptoms are tingling and numbness in the thumb, index and middle finger (median nerve distribution), aching in the forearm which can radiate to the shoulder and clumsiness or weak grip. Only about one or two patients out of ten presents with a classic textbook carpal tunnel picture. Some present with tingling in all fingers while others present with tingling only in the thumb or the middle finger. Some present with aching and pain in the hand while others have radiating pain just medial to the back.

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Detain X and Serotonin

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