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Carpal Tunnel Syndrome

Understanding carpal tunnel syndrome and the treatments available to you.

Carpal tunnel syndrome is a common condition causing numbness, pain, and tingling in the hand and arm.

The condition is caused by the swelling in the tissues surrounding the flexor tendons in the wrist. The median nerve, one of the major nerves in the hand, is being squeezed as it travels through the wrist. The carpal tunnel is a narrow passageway in the wrist, only about an inch wide. The roof of the carpal tunnel is a band of connective tissue called the transverse carpal ligament. The transverse carpal boundaries are rigid, so the carpal tunnel has no room to increase in size. The median nerve goes down the arm and forearm, passing through the carpal tunnel at the wrist. The median nerve provides feeling in the thumb, index, middle, and ring fingers. It also controls the muscles around the thumb. The tendons used to bend the fingers and thumb also travel through the carpal tunnel, and these are known as the flexor tendons.To further explain, carpal tunnel occurs when the tunnel narrows as the tissues surrounding the flexor tendons swell, causing pressure on the median nerve. The tissues are called the synovium. When everything is operating as it should, the synovium lubricates the tendons, allowing your fingers to move. When the synovium swells, it consumes the space in the carpal tunnel and eventually crowds the nerve. The abnormal pressure on the median nerve can result in pain, tingling, and numbness in the hand.

Most carpal tunnel syndrome cases are caused by many different factors.
Women and older adults are more likely to develop carpal tunnel syndrome.
Other common factors that cause carpal tunnel syndrome include:

Repetitive hand use or wrist and hand position

Repeating the same hand and wrist movements and activities for a lengthy amount of time can cause increased pressure on the nerve. Certain activities require extreme flexing and extending of the hand and wrist. Over a long period of time, this can cause swelling.


The carpal tunnel can be smaller in some people. There may also be anatomic differences that affect the amount of space for the nerve. Both these trails can be hereditary.


The hormonal changes a woman experiences during pregnancy can cause swelling..

Health conditions

Health conditions such as diabetes, thyroid gland imbalance, and rheumatoid arthritis are conditions commonly associated with carpal tunnel syndrome.

Common symptoms of carpal tunnel syndrome include:

For many, the condition gets worse over time. Early diagnosis and treatment are very important. At the start, symptoms can be relieved by simply wearing a wrist splint or limiting certain activities. As the pressure on the median nerve continues, nerve damage can occur and cause symptoms to worsen.Night-time symptoms are very common. Many people tend to sleep with their wrists bent, causing symptoms to worsen throughout the course of the night. Throughout the day, symptoms commonly occur when holding something for a long period of time with a bent wrist. This can include holding a phone or driving a car.To prevent permanent damage, surgery to take pressure off the median nerve may be necessary for some patients. It is important to be evaluated and diagnosed early on. If carpal tunnel is caught early on, it may be possible to slow down or stop the disease from progressing.If the carpal tunnel is caught early enough, it can often be relieved without surgery. If your symptoms are mild, nonsurgical treatment will be recommended first. This may include wearing a brace or splint. This will keep your wrist from bending while doing certain activities, including sleeping. Keeping your wrist in a straight position will reduce pressure on the nerve in the carpal tunnel. Activity changes will also relieve symptoms. If your job is recreational or requires activities that increase the swelling, modifying these activities will help slow down the disease. In severe cases, changing to your workstation may be necessary.If nonsurgical treatment cannot relieve your symptoms after an extended period of time, surgery may be recommended. The decision will be based on the severity of the symptoms and the amount of pain and numbness.

Meet the specialists

Michael D. Smith, M.D.

Dr. Michael Smith is very excited about the opportunity to return to his hometown and practice orthopedic surgery at Southlake Orthopaedics. Both Dr. Smith and his wife love Birmingham & Hoover, and think it is a great privilege to serve in such a dynamic community. Dr. Smith believes in patient-centered care that is thoughtful and focused on the patient’s goals. As a fellowship trained hand surgeon & upper extremity surgeon, he is happy to provide treatments for ailments related to the shoulder, elbow, hand or microvascular problems. Read more about Dr. Smith here.

Ekkehard Bonatz, M.D., Ph.D.

Ekkehard Bonatz, M.D., was born in Wernigerode, Germany. Dr. Bonatz graduated from the Hannover Medical School with a Medical Degree. He completed his orthopaedic surgery residency at the University of Alabama at Birmingham. Dr. Bonatz completed his fellowship in Hand and Microsurgery at UAB. Dr. Bonatz then volunteered for the U.S. Army as an officer in the Medical Corps at Fort Sam Houston, Texas, where he was acting Chief of Hand Surgery. He then joined the faculty at the University of Alabama Department of Surgery in Birmingham in the Hand and Microsurgery Program, eventually becoming an Associate Professor, Division of Orthopaedic Surgery. Subsequently, Dr. Bonatz entered private practice at Southlake Orthopaedics Sports Medicine and Spine Center. His practice is geared primarily to elbow, wrist, and hand problems. Read more about Dr. Bonatz here.