Carpal Tunnel Syndrome

Carpal Tunnel Syndrome 

What is Carpal Tunnel Syndrome? 

Carpal tunnel syndrome, also known as median nerve compression, is pressure on the median nerve in your wrist. It causes weakness, tingling, numbness, and other problems in your hand and finger. Carpal tunnel syndrome (CTS) can often be self-treated, but it can take a long period of time to heal.  

The median nerve runs the length of the arm, passes through the carpal tunnel (a passage in the wrist), and ends in the hand. The median nerve controls the feeling (sensation) and movement of your thumb and fingers (except the pinky). 

Causes

CTS is caused by pressure placed on the median nerve. This occurs when something (repetitive movement, strain, sprain, an injury, etc.) irritates or squeezes the median nerve in the carpal tunnel space. A wrist fracture can further narrow the carpal tunnel space and irate the nerve. Rheumatoid arthritis can also cause CTS, as inflammation and swelling, a characteristic of the disease, narrows the carpal tunnel space.

In many cases, there are no single causes of CTS but rather a combination of risk factors that contribute to the development of the condition.  

Symptoms 

Carpal Tunnel Syndrome symptoms include:

• A weak thumb or difficulty gripping objects
• Pain or an ache in your fingers, hand, or arm
• Tingling or pins and needles
• Numb hands
• Shock-like-sensations that move into your fingers

As the condition progresses, the median nerve is unable to work the way it should be, leading to:

• Less feeling in your finger
• Less coordination and strength, especially in the thumb
• Slower nerve impulses

Diagnosis 

Your doctor will ask you for a history of symptoms, conduct a physical exam, and may conduct a Tinel sign. Other tests that may be performed include:

• Imaging tests such as X-rays, MRI exams, and ultrasounds. 
• Electromyography, this test measures electrical activity in the muscle. 
• Nerve conduction studies. This test measures the signals in the nerves of your arm and hand. 

Treatment 

Treatment for CTS depends on the progression of the condition, individual symptoms,and whether there is nerve damage. If your symptoms are mild, at-home treatment for a few weeks may help relieve your symptoms.  

At-home treatment and management:

• Take short, frequent breaks from repetitive tasks
• Stretch it out – hand exercises 
• Mind your wrist flexors
• Over-the-counter medications such as Ibuprofen and aspirin
• Stay warm 
• Ice your wrist for 10 – 15 minutes 1-2 times every hour

Nonsurgical treatment:

• Corticosteroids, such as cortisone, are used to reduce the inflammation causing pressure on the median nerve.  
• Wrist splinting 
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Physical and Occupational therapy 
• Ultrasound therapy 
• Acupuncture

Surgical treatment: 

Surgical treatments are considered if noninvasive treatments have not improved your symptoms in 6 months. Your doctor may suggest carpal tunnel release surgery, of which there are two types:

• Open surgery
• Endoscopic surgery 

In both surgeries, the ligament atop the carpal tunnel is cut to take pressure off the median nerve. After surgery, the ligament comes back together, with more room for the nerve to pass through the carpal tunnel. 

Both surgeries are reported to have similar results.