Often known as CTS, carpal tunnel syndrome is an injury to the median nerve as it crosses through the tunnel connecting the end of the forearm to the palm side of the wrist and hand. The median nerve carries sensation from the palm, thumb, index finger, middle finger and half the ring finger through the wrist canal (carpus means wrist), up the arm into the spinal cord and up to the brain. It also carries motor nerve signals from the brain down the arm through the wrist and into the hand controlling the muscles of the thumb predominantly. Symptoms of carpal tunnel syndrome include a painful numbness, most prevalent at night. Patients often wake up in the middle of the night and have to shake their hand because it “falls asleep.”  In more severe cases, weakness and even atrophy of the thumb muscles become apparent. Certain occupations are more prone to carpal tunnel syndrome including dental hygienist, musicians, roofers and typists to name a few. Certain general medical conditions also predispose one to carpal tunnel syndrome, such as  diabetes, rheumatoid arthritis, thyroid and parathyroid gland disorders, and pregnancy.  Diagnosis of carpal tunnel syndrome is based on the history and physical exam.  Confirmation of the diagnosis can and should be made with electrodiagnostic testing and nerve conduction studies. These are performed at Dr. Portner’s office by trained electromyographers. Treatment of carpal tunnel syndrome varies, depending on the underlying cause. If the carpal tunnel syndrome is a secondary complication of an underlying disease process, this must be addressed first. If the cause is due to repetitive overuse injuries then this activity must be modified. Wearing a splint at night is often effective. Certain medications, such as gabapentin, can be useful. An injection, usually done under the guidance of fluoroscopic or ultrasonic equipment, is usually very effective.  In rare cases, surgical release of the carpal tunnel ligament will give the median nerve more room and cure the syndrome. Not all numbness in the hand is carpal tunnel syndrome, but all numbness in the hand should be investigated without unnecessary delay as this can otherwise result in permanent nerve injury and weakness.