Excessive repetitive movements of the arms, wrists or hands can cause injuries that could become chronic conditions. When detected early enough, however, hand-wrist injuries can be treated, and recovery is possible in a few months. Severe hand injuries can also be treated, but recovery may take up to a year or longer.

The carpal tunnel is the passageway in the hand made up of the median nerve, tendons and the carpal bones (eight bones in the wrist). Carpal tunnel syndrome occurs when the nerve passing through the wrist (called the median nerve) becomes pinched by irritated, swollen tendons. The swollen tendons put pressure on the median nerve where it passes through the gap under a ligament in front of the wrist. This pressure causes numbness and pain in the middle fingers.

Usually, people with carpal tunnel syndrome first notice that their fingers "fall asleep" and become numb at night -- they often wake up with numbness and tingling in their hands. Burning pain is frequently associated with this feeling of numbness, and it generally runs up the center of the person's forearm, sometimes as far as the shoulder. As carpal tunnel syndrome becomes more severe, symptoms are noticed during the day.

When chronic irritation occurs around the median nerve, it becomes constricted and is continually pushed against the ligament above it. When the median nerve in the hand is continually constricted, it can become compressed to the point that it begins to deteriorate. This results in a slowed transmittal of nerve impulses, which may cause a loss of feeling in the fingers and a loss of muscle function at the base of the thumb. If the condition is not treated, it could result in a deterioration of muscle tissue.

Treatment first involves adjusting the way the person performs the repetitive motion by:

• Changing the frequency with which the person performs the motion.
• Changing the amount of time the person rests between periods of performing the motion.

Treatment also includes immobilizing the wrist in a splint to minimize or prevent pressure on the nerves. Splints that support the wrist in a comfortable neutral position can be of great value if worn at night to relieve painful numbness or tingling. Patients may be given short courses of anti-inflammatory drugs or injections of cortisone or steroids in their wrist to reduce swelling. Injections are usually temporary and are best reserved for people who have carpal tunnel syndrome as a result of an acute (sharp or severe) flare-up of tenosynovitis (an inflammation of the sheath around the tendon). Injections are also used to treat people who have an inflammatory disease, such as rheumatoid arthritis. If carpal tunnel syndrome does not respond to conservative treatment, then surgery is the next treatment option.

During surgery, your doctor will open the carpal tunnel and cut the ligament at the bottom of the wrist, relieving the pressure. Carpal tunnel surgery is quite effective when the condition only involves nerve constriction. Relief of painful symptoms is excellent and nerve degeneration is almost always reversible. When carpal tunnel syndrome is just one symptom of a more serious disorder, the results of surgery are not always very good. The difficulty is not in recovering from the operation, but in recovering the ability to return to work, especially to the same job that caused the disorder to occur.

Sometimes an electromyogram that includes nerve conduction studies is done to document the extent of nerve damage.