A Tight Fit

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by Daniel Allan, M.D.

The wrist is the joint between the forearm and the hand. It is also a bottleneck through which pass nine tendons that move the fingers, and the principle sensory nerve of the hand. This narrow channel called the carpal tunnel, is bounded on three sides by bone and on the forth side by a thick fibrous ligament. Sometimes the tunnel becomes too tight, and the nerve is impressed, producing pain, numbness, and tingling in the fingers. This is called carpal tunnel syndrome. It can be associated with a variety of conditions. Pregnancy can cause swelling in the carpal tunnel as it does elsewhere in the body, and the symptoms usually resolve after delivery. Diabetes, rheumatoid arthritis and thyroid disease may also be responsible and treatment of these conditions may also bring improvement. In most cases, however, there is no underlining disorder. When the symptoms and examination suggest carpal tunnel syndrome, a nerve condition study is frequently obtained. This test measures how well the nerve is conducting electrical impulses.

While anti-inflammatory medications may give temporary relief, the definitive treatment of carpal tunnel syndrome is surgery. This does not require an overnight hospital stay or a general anesthetic.

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