Clinical features

The most common symptoms of carpal tunnel syndrome are tingling, numbness,

weakness, or pain felt in the fingers or, less commonly, in the palm. Symptoms most

often occur in the parts of the hand supplied by the median nerve: the thumb, index

finger, middle finger, and half of the ring finger. If your little finger is not affected, this

may be a sign that the condition is carpal tunnel syndrome, because the little finger is

usually controlled by a different nerve than the thumb and other fingers.The symptoms of

carpal tunnel syndrome often occur in both hands, but symptoms are usually worse in one

hand than the other. You may first notice symptoms at night. People with carpal tunnel

syndrome can usually fall asleep, but pain or numbness may wake them up.

Pain

The most common sign of carpal tunnel syndrome is pain in the wrist that can extend to

the palm and fingers, and in some cases to the forearm or shoulder.

Numbness

Tingling or numbness in the hand or fingers is a sign of the disorder. It usually occurs

when gripping an object like a phone and all the fingers feel numb except the pinky.

numbness in your fingers or hand, especially your thumb and index, middle or ring

fingers, but not your little finger. This sensation often occurs while holding a steering

wheel, phone or newspaper or upon awakening. Many people "shake out" their hands to

try to relieve their symptoms. As the disorder progresses, the numb feeling may become

constant.
 Weakness –

Difficulty in holding objects or dropping them is a symptom of carpal tunnel syndrome.,

it occur due to repetitive stress on the the carpal ligament and other wrist structures

which cause swelling and inflammation impinging on the nerve. This causes

weakness in the hand and fingers.

Swelling –

Occasionally, the hand becomes swollen due to pressure on the nerve.

Persistence –

If pain, numbness and weakness continue for several weeks, you should see a doctor. If

left untreated, carpal tunnel syndrome can lead to nerve or muscle damage.

Mild carpal tunnel symptoms primarily affect the hand and sometimes the forearm, but

they can radiate up to the shoulder. Symptoms include:

1. Numbness or pain in your hand, forearm, or wrist that awakens you at night. (Shaking or

moving your fingers may ease this numbness and pain.)

2.Occasional tingling, numbness, "pins-and-needles" sensation, or pain. The feeling is similar

to your hand "falling asleep."

3.Numbness or pain that gets worse while you are using your hand or wrist, especially when

gripping an object with your hand or bending (flexing) your wrist.

4.Occasional aching pain in your forearm between your elbow and wrist.

5Stiffness in your fingers when you get up in the morning.

With moderate or severe carpal tunnel symptoms, you may have numbness or reduced

strength and grip in your fingers, thumb, or hand. It may be difficult to:

1.Do simple hand movements, such as brushing your hair or holding a fork. You may

accidentally drop objects.

2.Pinch an object between your thumb and first finger (loss of pinch strength).

3.Use your thumb while doing simple tasks such as opening a jar or using a screwdriver.

With long-lasting carpal tunnel syndrome, the thumb muscles can get smaller and weaker

(atrophy).
Pathophysiology

The pathophysiologic basis for carpal tunnel syndrome is, in most instances, unknown.

The carpal canal normally contains only the median nerve, the flexor tendons of the digits

and the synovial lining of the tendons. The median nerve is compressed when the space

available to it is decreased within the finite volume of the carpal canal. Conditions that

cause synovial swelling are known to be associated with carpal tunnel syndrome.

Pregnancy and rheumatoid arthritis are two well-known examples. Conditions like

acromegaly and hypothyroidism may also be associated with carpal tunnel syndrome but

these conditions are relatively rare, especially in the context of work-related symptoms of

carpal tunnel syndrome.

Studies of biopsy specimens taken from the flexor tendon synovium at the time of

surgery to perform a carpal tunnel release, show edema of this tissue even in patients not

known to have a condition which is associated with swelling. This observation suggests

that flexor tendon synovial edema may be the cause of median nerve compression but the

immediate cause of the swelling in these cases is not known.

Intrinsic abnormalities of the median nerve itself may also act to lower the threshold for

symptomatic compression. Pressures within the carpal canal that might not otherwise

cause symptoms of carpal tunnel syndrome may do so if the nerve is rendered particularly

sensitive to pressure by some other disease or condition. A common example of this is

diabetes mellitus, which frequently affects peripheral nerve function. Peripheral nerves,

including the median nerve, are a target of diabetes and in individuals with this condition,

carpal tunnel syndrome may occur even where the pressure in the carpal canal is
insufficient to cause these symptoms in a non-diabetic individual. In this sense, diabetes

may be considered a pre-existing condition that predisposes the median nerve to

symptoms of compression under circumstances where this might not otherwise occur.

Other diffuse peripheral nerve diseases may also play a role in the development of

symptoms of carpal tunnel syndrome but these are also very rare conditions which will

usually be known to be present in an individual before symptoms of hand numbness are

attributed to carpal tunnel syndrome.

A much less clear, but related concept is that of "double crush". In the double crush

syndrome it is thought that sub-clinical compression of the median nerve at several points

in its course between the spinal cord and the carpal tunnel, lowers the threshold for

symptomatic compression at level of the carpal canal. While this idea fits in with some of

what is known about peripheral nerve function, it is a largely unproven hypothesis.

Furthermore, it can rarely be shown to be present in clinical cases of carpal tunnel

syndrome and should seldom, if ever, play a role in the diagnosis or management of

carpal tunnel syndrome.