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Carpal tunnel syndrome



The carpal tunnel syndrome (CTS) is the most common peripheral neuropathy of the hand by entrapment. It is caused by the compression of the median nerve at the wrist. It is more frequent in females 2:1,between 40 and 60 years old,with another peak at the age of 75 approximately and with a clear occupational component. The current incidence rate is of 0’1%,while it is of 15 to 20% among the working population.

It is a problem of the peripheral nervous system but it is caused by the musculature in more than 80% of the cases.

The symptoms are bilateral in 50% of the patients. The carpal tunnel syndrome is the main cause of acroparesthesias in the upper extremity.

The median nerve provides sensation and movement to the side of the palm of the hand. This includes the palm side of the thumb,index,middle and ring fingers.

The part of the wrist where this nerve enters in the hand is called carpal tunnel and it is normally narrow. Any swelling can compress the nerve and cause pain,numbness,tingling or weakness,what it is called carpal tunnel syndrome.


– Idiopathic cause(not specific hypertrophic degeneration of the annular ligament),up to 50% of the cases.
– Traumas and microtraumas(badly healed fractures,Colles’ fractures,calluses,workers of pneumatic machines,housewives,etc).
– Inflammatory arthritis: rheumatoid arthritis,lupus,etc.
– Microcrystalline arthritis: gout,chondrocalcinosis,etc.
– Endocrinopathies: diabetes mellitus,hypothyroidism,acromegaly, etc.
– Tenosynovitis of the flexors.
– Pregnancy.
– Contraceptives.
– Deposit diseases: amyloidosis,copolysaccharidosis.
– Arthropathy of hemodialyzed patients.
– Multiple myeloma.
– Ganglions.
– Tumours: lipoma,hemangioma,etc.
– Infections: Lyme disease,septic arthritis,etc.
– Obesity.
– A control case study identified a number of risk factors in the general population,such as the repeated flex-extension of the wrist,fast food diets,low weight,hysterectomy with oophorectomy and recent menopause.

Although the pathology of carpal tunnel presents a number of the above-mentioned etiologies,we can distinguish between acute and chronic condition. The acute type is not usually very common and it is caused by a quick and sustained increase in the pressure in the carpal tunnel,it is normally due to a radius fracture as well as burns,coagulopathy,local infections and injections. The chronic type is much more frequent and the symptoms can continue for months or even years.

The CTS is the most common syndrome caused by repeated trauma. In USA it represents almost the 62% of all the reported cases of occupational disease. Occupations at risk: shredders,cashiers,packers and butchers,car seat sewing workers,grocery store workers and a large part of the assembly lines.

We have to make a differential diagnosis from a number of pathologies such as: cervical disk herniation,throracic outlet syndrome,compression of the median nerve on another level.

Some people with this problem were born with a small carpal tunnel.

The carpal tunnel syndrome can be caused as well by the repetition of the same movement with the hand and the wrist.

The use of manual tools that vibrate can cause too this syndrome.

Studies have not proven that the carpal tunnel syndrome is caused by writing on a computer,using a computer mouse or repeating movements while working,playing a musical instrument or practising sports;but these activities can cause pain and swelling of the tendons or the bursa.


– Clumsiness of the hand when holding objects.
– Numbness or tingling in the thumb and in the next 2 or 3 fingers of one or both hands.
– Numbness or tingling in the palm of the hand.
– Pain spread to the elbow.
– Pain in the hand or in the wrist in one or both hands.
– Problems with the delicate movement of the fingers(coordination)in one or both hands.
– Atrophy of the muscle below the thumb(in advanced or long-term cases).
– Weak grasp or difficulty to carry bags(a common complaint).
– Weakness in one or both hands.

Tests and examinations

During a physical examination,the doctor can find:
– Numbness in the palm of the hand,the thumb,the index,the middle and the palm side of the annular finger.
– Weakness when grasping with the hand.
– Tapping on the median nerve at the wrist can trigger the pain from the wrist to the hand(this is called Tinel’s sign).
– Bending the wrist forward completely for 60 seconds will usually cause numbness,tigling or weakness(this is called Phalen’s test).
– Durkan’s sign: the physician pushes with his thumb on the palm side of the wrist,in the area located between the thenar and hypothenar eminences(area with the biggest narrowing of the canal),triggering the symptoms if there is narrowing of the passage.
– Pyse-Phillips’ sign: disappearance of the symptoms when raising the affected limb.

The medical tests that can be ordered are:
– X-rays of the wrist in order to rule out other conditions such as arthritis of the wrist.
– Electromyography(EMG,a test that measures and records the electrical activity of the muscles).
– A nerve conduction velocity study(a test that measures the speed and degree of electrical activity in a nerve).


It is advisable to use tools and equipments with an appropiate design in order to reduce the risk of wrist injury.

Ergonomic aids,such as split keyboards and wrist braces,can be used to improve wrist posture. Take frequent breaks when typing and always stop if you feel pain or tigling.

When to contact a medical professional?

Consult a doctor:
– If you have symptoms of the carpal tunnel syndrome.
– If the symptoms don’t improve after a regular treatment such as rest and anti-inflammatory drugs,or if there seems to be a loss of muscle mass around the fingers of the hand.


The doctor can recommend you the following:
– To wear a wrist splint at night for several weeks. If this doesn’t help,it may be necessary to wear it during the day as well.
– To avoid sleeping on the wrists.
– To apply cold or hot compresses to the affected area.


Nonsteroidal anti-inflammatory drugs(NSAIDs)and corticosteroids used in the area of the carpal tunnel can relieve the symptoms for a period of time.


The release of the carpal tunnel is a surgical procedure in which the ligament that is compressing the nerve is cut. The surgery is effective in most of the cases,but it depends on how long the nerve compression has persisted and its seriousness.

Bosch Technique

The treatment of the Bosch technique is based on the discharge of the muscularure of the forearm. This can be done manually as well as with needles. This second option is quicker but as effective as the first one.

With the Bosch technique, patients that had proven all the current treatments and were in the waiting list for surgery,when they visited Rafael Bosch clinic and started their treatment,they began to get better from the first session. After 5 sessions,patients reached almost the 100% of recovery in the EVA pain scale,disappearing all the symptoms of this injury.


In our Bosch Clinical Centre we will attend to you and make you a profesional diagnosis.

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