Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Carpal Tunnel Syndrome

Carpal tunnel syndrome is most often caused by overuse of the wrist, which in turn causes narrowing and inflammation of the tunnel that houses the nerves and tendons that lead from the forearm to the wrist.
Compression of the median nerve causes the symptoms. Overuse is common in hand-intensive activities, particularly when the wrist is used for support, as in cycling.

Symptoms and diagnosis

– Tenderness over the palmar aspect just distal to the wrist.
– Athletes with this injury may have intermittent tingling and numbness in the thumb and the next two and a half fingers. The tingling will be more prominent with the wrist in hyper flexion or hyperextension.
– The athlete will sometimes complain of clumsiness and loss of dexterity.
– In prolonged severe cases there may be loss of grip strength and hypotrophy of the thumb muscles.
– Holding the wrist in hyperflexion (Phalen’s maneuver, Figure 8.8) for a 30 second period causes numbness in the hand.
– Electromyographic studies may be helpful to confirm the diagnosis, but they are not always positive.

Treatment

The doctor may:
– advise a change in training;
– apply a splint to rest the wrist and avoid extremes of range of motion. Depending on the degree of symptoms the splint or brace may be worn only at night, during activities, or continuously;
– give anti-inflammatory medication;
– inject steroid into the carpal tunnel in refractory cases;
– operate to release the ligament overlying the carpal tunnel in cases refractory to the above measures (this increases the space available for the nerve). This surgery can be ‘arthroscopic’ (endoscopic).

Healing

The athlete may return to sports as soon as symptoms allow, often within 2–4 weeks of surgery. Taping, bracing or splinting may be helpful during activities.

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