Anatomy
On the palm side of the wrist, the flexor tendons are retained in the carpal tunnel, which is a canal that is bounded on the inside by the wrist and whose ceiling consists of a strong, transverse ligament (retinaculum flexorum). The carpal tunnel is approximately 5 cm long. The median nerve runs together with the flexor tendons in the carpal tunnel, while the ulnar nerve runs in a smaller tunnel (Guyon’s canal) in the little finger side of the wrist (ulnar nerve).
Cause of the problem
Repeated bending and stretching movements of the wrist (handball, racket sports, rowing) and prolonged direct loading (cycling and wheelchair use in disability sports) cause irritation of the median nerve
Symptoms
Tingling and pins and needles (paraesthesia) in the 1st-4th fingers and pain in the wrist area. The sense of touch is affected and there may be reduced strength in the hand when dropping things. Gradually, pain may develop at rest.
Examination
The diagnosis is made through a clinical examination. There is often tenderness when pressing on the carpal tunnel and when tapping the skin over the nerve with a finger, there may be sensory disturbances in the 1st-3rd fingers and the outer (lateral) part of the 4th finger (positive Tinel’s sign).
See ultrasound scan showing thickening of the median nerve.
A nerve conduction velocity measurement can be performed, which is rarely necessary as the study is associated with some uncertainty.
Treatment
Reduction of pain-triggering activity. If the discomfort does not subside with load reduction and careful rehabilitation within the pain threshold, medical treatment in the form of arthritis pills (NSAIDs) or ultrasound-guided injection of adrenal cortex hormone can be added (Lam KHS, et al. 2023).
If relief and injection action do not have a lasting effect, the transverse connective tissue layer in the carpal tunnel can be divided to relieve pressure on the median nerve. This can be done by a simple ultrasound-guided splitting with a small hook (Krogh TP, et al. 2023) or by surgery (Schäfer L, et al. 2022).
Rehabilitation
Usually, cardio training in the form of running and rehabilitation according to the guidelines under rehabilitation can generally continue unchanged.
Usually, cardio training in the form of running and rehabilitation according to the guidelines under rehabilitation can generally continue unchanged.
Bandage
You can stabilise and relieve the wrist with a stiff wrist bandage or tape. See tape
