A: In some studies, carpal tunnel syndrome occured in up to 25% of European sport climbers.

In essence, the carpal tunnel is a tunnel in the wrist, covered with a thick fibrous band, through which many tendons, and one major nerve (median nerve) pass on route to the hand. Anything which takes up space in the tunnel can lead to compression of the median nerve, giving the symptoms of carpal tunnel syndrome:

1. Thickening of the tendons or tendon covering (tenosynovium)
   • Rheumatoid arthritis
   • Gout
   • Amyloidosis
   • Tuberculosis
2. Thickening of the joint lining (synovial fibrosis)
3. Thickening of the transverse carpal ligament
4. Fluid buildup in the tunnel
   • Pregnancy
   • Thyroid disease (hypothyroidism)
   • Kidney disease (dialysis)
5. Lesions which occupy space in the tunnel
   • Lipoma (Buildup of fat / adipose)
   • Ganglia (Buildup of nerve fibers)
   • Fluid buildup following fractures (Edema)
6. Other causes of nerve damage
   • Diabetes
   • Alcoholism
   • Chronic Renal Failure

Carpal tunnel syndrome is often aggravated by activities involving repeated bending of the wrist in either direction (flexion / extension).

Q: What are the most common symptoms? When the doctor examines me, what can he or she see?

A: Often the symptoms of carpal tunnel syndrome are present in a mild form for months or years, and the victim seeks medical attention only after a particularly bad worsening of symptoms.

The earliest symptom may be tingling in the fingers at night, usually the ring and middle finger. The small finger is usually not affected. The feeling of tingling may radiate up to the forearm, elbow, and shoulder, and be aggravated by holding things (reading a newspaper, holding the telephone). In time, numbness may occur in the same fingers. These symptoms usually occur on both hands.

In the physician's office the usual routine takes place: the doctor tries to make the pain come back in the office. Sometimes pressure on the carpal tunnel (Tinel's sign) or holding the wrists bent (Phalen's test) may reproduce the numbness / tingling. The physician will also likely test sensation of the affected fingers, and look for muscle weakness in the hand (resisted palmar abduction of the thumb).

Further studies may be needed. Often nerve conduction studies can help make the diagnosis. However, some people with carpal tunnel syndrome can have normal nerve studies.

Q: Please help me. I have had carpal tunnel syndrome, and it won't go away. I tried a splint, but I can't wear it during the day because of my job. I do wear it at night, but it doesn't always help. What other treatments are possible?

A: Carpal tunnel syndrome treatment is not always easy, and it is best to ensure you are followed by a good orthopedic surgeon if possible. The general progression of treatment is as follows:

1. Treating any known cause of the carpal tunnel syndrome.
2. Looking at predisposing ergonomic factors (occupation, recreation, etc) and modifying stresses on the wrist where possible.
3. A trial of steroid injections into the wrist area. This may provide immediate relief of symptoms, but this may be temporary only.
4. Splinting of the wrist (24 hours/day if possible but certainly at night) to prevent bending of the wrist.
5. Surgery: Sectioning (cutting) of the carpal tunnel ligament

   Often the maneuvers prior to surgery are temporary, and surgery is required to releive the symptoms permanently. Following surgery a splint is used, and motion of the fingers is encouraged. Complications of surgery are rare but may include nerve injury, scaring, or incomplete relief of symptoms.

   Results of surgery are usually favorable. The tingling may improve very quickly, while improvement in numbness may take longer or be incomplete. The strength of the hand often takes longer to recover.

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