Carpal Tunnel Syndrome

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 16 May, 2011



The transverse carpal ligament is the roof of the carpal tunnel, through which pass the median nerve and finger tendon flexors. The median nerve provides sensory innervation to the thumb, forefinger, middle finger and half of the ring finger, as well as motor innervation to some hand muscles.


If the carpal tunnel space is reduced due to inflammation and oedema, or if there is hypertrophy of the ligament because of its overuse, then the space where the median nerve runs is reduced and the nerve cannot function normally.


The patient feels pain, numbness and needle sensation in fingers that are innervated by the median nerve. In some patients, the pain radiates to the forearm, upper arm, shoulder and neck. There is muscle weakness in fingers. Pain may be reproduced with pressure upon the carpal tunnel by the examiner’s thumb for about a minute.


•    Electromyography (EMG)


•    Rest and stretching exercises designed for opening up the carpal tunnel space. Place the two palms opposite one the other and exert pressure in such a way that the wrists form a 90o angle with the forearms. This may instantly aggravate the pain but it also stretches the tunnel and, in the long run, reduces the nerve compression.

•    Oral anti-inflammatory drugs  rarely help.
•    Injection of corticosteroids within the carpal tunnel has an anti-inflammatory effect and reduces the oedema (ATTENTION: DO NOT inject into the nerve),  .

•    Surgical decompression with dissection of the transverse ligament (in case all previous treatments have failed)