Carpal tunnel syndrome
Carpal tunnel syndrome is a condition where there is compression of the nerve - called the median nerve - which supplies sensation to the thumb, the forefinger, the middle finger and sometimes one side of the ring finger (sensation to the little finger and the other side of the ring finger is supplied by the ulnar nerve) at the point where it enters the hand at the front of the wrist. It passes through a tunnel formed by the bones of the wrist behind (the carpal bones) and a band of fibrous tissue in front. Initially there are pins and needles in the thumb and fingers, progressing to numbness, associated with pain which spreads up the forearm and is often worse at night. It is associated with a number of different conditions: pregnancy, diabetes mellitus, thyroid failure, rheumatoid arthritis and very rarely acromegaly - the condition where there is excess production of growth hormone by cells in the pituitary gland, causing the bones of the wrist to swell. Most cases, however, arise out of the blue. It may be helped by the use of splints to extend the wrist, by injections of steroid into the carpal tunnel, or by a small dose of diuretics. In chronic and severe cases operation to release the nerve may be required. Anti-inflammatory painkillers, because they may cause fluid retention, can make the symptoms worse.
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