A deep dive into the carpal tunnel

What actually is it, what does it do… why does everyone seem to have a problem with it these days?

We get a lot of queries from people trying to find out about carpal tunnel syndrome, how to avoid it and how to deal with it if you didn’t… it would seem that it’s a part of our anatomy that’s a source of much misery and misunderstanding. So, what actually is it, what does it do… why does everyone seem to have a problem with it these days?

Workers on the Home Tunnel. Carpal tunnel syndrome probably wasn’t a big concern for them. Frostbite, avalanches and accidents on the other hand…

The short answer is: it’s complicated. A lot of carpal tunnel syndrome cases are described as “idiopathic”, which is really just a way of saying, “I don’t really know”… while still sounding brainy.

What we do know is that the *mechanical* cause of carpal tunnel syndrome is when your flexor tendons and your median nerve run out of room as they travel under the transverse carpal ligament at the base of your palm (aka the carpal tunnel). This is usually because the tendons have become inflamed for some reason, the result is they don’t play nicely with your median nerve – and the nerve comes off second best, causing pain, tingling and numbness in your thumb, index and middle fingers.

Sometimes the root cause will be mechanical – some sort of task you’re repeatedly doing with bad ergonomics that’s giving your flexor tendons a bit of a rev-up. Sometimes it’ll be related to pregnancy or arthritis. Sometimes it’ll be related to an injury or surgery… but often it’s just because you got a bad deal of the genetic cards, which makes you predisposed to it – thanks mum and dad!   

The good news is it’s usually a reasonably straightforward problem to fix. A good hand therapist will establish if there’s any ergonomic issues that are causing it and give you recommendations on how to adjust your lifestyle to resolve it the easy way. They can also help with massage and exercise programmes. They can make you a custom splint to wear at night (which has some really strong evidence supporting it).

If necessary, they can refer you to a GP to prescribe medications or an orthopaedic surgeon to do a carpal tunnel decompression procedure. That sounds a bit drastic, but it’s usually just a matter of a small (3-5cm) incision at the base of your palm that’s done under a local anaesthetic.  

It’s worth pointing out that you should see someone who really knows what they’re doing. Some people will use techniques like trans electrical nerve stimulation and ultrasound… which are about as evidence-based as thoughts and prayers.

If you’re having symptoms that sound like they might be carpal tunnel related. It’s probably a good idea to drop by and get it looked at sooner rather than later. Early interventions tend to be more effective with these sorts of things, plus the sooner you get it seen to the sooner you can get to doing things that are more fun than reading medical articles like this!

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