What is it?
One of the nerves on the wrist called the “median nerve” passes through a tunnel in the wrist called the carpal tunnel. When athletes put pressure on their wrists (like when doing handstands in gymnastics or when leaning on handlebars in cycling), the median nerve can be get inflamed, irritated or damaged. The median nerve controls muscle strength and skin sensation over specific parts of the hand and wrist. It controls a few small muscles at the base of the thumb and sensation to the palmar side of the thumb, index finger, middle finger, and half of the ring finger. Carpal Tunnel Syndrome is caused by repetitive pressure on the wrist and/or injury to the wrist, as with a wrist fracture.

Symptoms

• Numbness, tingling, pain and/or weakness of the hand, particularly movements of the thumb
• These may occur anytime, but are most common during or shortly after activity and at night

Sports Medicine Evaluation and Treatment
A physician will ask the athlete specific questions about symptoms and perform a careful physical examination looking for damage to the nerve. A sports medicine physician will evaluate factors that may make the athlete more prone to getting the condition. He or she may recommend changes specific to the athlete’s activity, like frequent hand repositioning, using a different racquet for tennis players, changing golf swing technique for golfers, or changing handlebar positions for cyclists. Simply adding padding may also help.
 

Treatment typically involves rest; further medical intervention is often unnecessary. Wrist splints may be worn at night to help with nerve healing. However, if symptoms persist for more than two weeks, or worsen, athletes should consult a medical professional for further evaluation. Although symptoms are rarely permanent, if numbness or weakness of the hand has developed, recovery can take a long time. Surgery, which involves cutting the thick ligament over the tunnel by an orthopedic surgeon, may be needed in some cases.   
 

Injury Prevention
Avoiding repetitive activities, making sure sports equipment (bike handlebars, golf clubs, tennis/racquetball racquets, etc.) are of proper fit, and changing activities frequently, may prevent development of Carpal Tunnel Syndrome.
 

Return to Play
Athletes can usually return to their normal level of activity once symptoms go away after a period of rest. If the nerve damage has led to weakness in the muscles around the thumb, certain activities like golf and tennis might be more difficult to get back into.
 

AMSSM Member Authors: BJ Deimel, MD and Chris Madden, MD

References
Akuthota, Venu et al.  The Effect of Long-Distance Bicycling on Ulnar and Median Nerves:  An Electrophysiologic Evaluation of Cyclist Palsy. The American Journal of Sports Medicine (2005). Volume 33: 8, 1224-1230.
Madden C, McCarty E, Putukian M, Young C. Netter’s Sports Medicine. Saunders Elsevier; 2010.