Carpal Tunnel Syndrome (CTS)
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is a common condition that affects the hand and wrist. It occurs when the median nerve in the wrist is compressed, known as compressive neuropathy. The median nerve carries signals for sensation and muscle movement. When the median nerve is compressed or entrapped, it cannot function properly.
The carpal tunnel is a space in the wrist bound on three sides by bone and covered with a ligament through which nine tendons and the median nerve travel to the fingers. This nerve supplies sensation to the thumb, index, middle, and half of the ring finger while providing innervation of muscles that control thumb motion.
When the median nerve is compressed, it results in increased sensitivity, tingling, pain, weakness, or numbness in the fingers, hand, and wrist; the little finger remains largely unaffected. Night symptoms of numbness and/or pain are common in those suffering from this condition.
What Causes Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome develops when the tissues and tendons in the Carpal Tunnel swell and make the area within the tunnel smaller, resulting in diminished blood supply and nerve dysfunction. Carpal tunnel syndrome often is the result of many factors, all of which increase pressure on the nerve at the level of the wrist.
Common contributing factors include:
- Trauma or injury to the wrist that causes swelling
- Hyperactive thyroid
- Rheumatoid arthritis
- Joint dislocation
- Mechanical problems in the wrist joint
- Repeated use of vibrating hand tools
- Fluid retention during pregnancy or menopause
What are the Symptoms of Carpal Tunnel Syndrome?
The primary symptoms of Carpal Tunnel Syndrome are:
- Pain, numbness, and tingling in the thumb, index, middle, and half of the ring finger
- Pain may be a deep ache or burning
- Pain may radiate up the arm
- The thumb may feel weak and clumsy
- Difficulty grasping items, and/or dropping things
- Symptoms may be more pronounced at night, when you perform certain activities, or in cold temperatures.
- In severe or untreated cases, the muscles at the base of the thumb may deteriorate and some people may not be able to tell between hot and cold by touch.
- Activities that require an individual to place pressure directly over the wrist region (bicycling, gymnastics, tennis, etc.)
How is Carpal Tunnel Syndrome Diagnosed?
The diagnosis of carpal tunnel syndrome is made primarily by clinical examination and the patient’s history of symptoms. Early diagnosis is important so that permanent damage to the median nerve is prevented. A physical examination will focus on hands, arms, shoulders, and neck. Not all finger numbness or tingling is Carpal Tunnel Syndrome. Routine laboratory tests and x-rays can help rule out diabetes, arthritis, fractures, and other conditions which involve symptoms similar to those of Carpal Tunnel Syndrome. Confirmation of the diagnosis with the use of nerve electrodiagnostic testing is often useful.
In some cases, physicians use nerve conduction studies to measure how well the median nerve works and to help specify the site of compression. Physicians commonly use a test called a Nerve Conduction Velocity (NCV) test. During the study, a nerve is stimulated in one place and the amount of time it takes for the message or impulse to travel to a second place is measured.
An Electromyography (EMG) test is often done at the same time as the NCV test. An EMG measures the impulses in the muscles to identify poor nerve input. Healthy muscles need impulses to perform movements. The physician will place fine needles through your skin and into the muscles that the median nerve controls. The physician will be able to determine the amount of impulses conducted when you contract your muscles.
What are the Treatment Options for Carpal Tunnel Syndrome?
It is important that patients pursue proven options for Carpal Tunnel Syndrome. Treatments range from the use of splints, braces, and medications to surgery. The symptoms of Carpal Tunnel Syndrome can often be relieved without surgery. Some cases respond to treatments that relieve pain and provide rest. Options may include the following:
- Nighttime Splinting – Keeps the wrist in a neutral position to prevent flexing or moving the wrist during sleep.
- Steroid Injection – A steroid is injected into the carpal tunnel to reduce inflammation; this usually provides temporary relief, unless surgery is not an option.
- Surgery – If the EMG findings are positive for nerve compression, the preferred treatment is surgery to release the carpal tunnel.
- Occupational Therapy – Helps patients improve daily functions and use of the hand and wrist.
- Exercises – Exercises, such as nerve glides, improve the elasticity of the nerve.
Surgery is recommended when non-surgical options do not work or if the condition becomes worse. There are a few types of outpatient surgery to remove pressure on the median nerve. Your physician will help you decide which option is best for you.
- Open Release – The standard surgery for Carpal Tunnel Syndrome is called an Open Release. The surgeon will use a local or regional anesthetic to numb the hand area. For this procedure, the surgeon makes a two to three inch opening along the palm. This allows the surgeon access to the Transverse Carpal Ligament, the roof of the Carpal Tunnel. The surgeon makes an incision in the Transverse Carpal Ligament to open the tunnel and make it larger. By doing so, pressure is taken off of the median nerve. The surgery time for an Open Release is short, only about fifteen minutes.
- Endoscopic Carpal Tunnel Release – This type of surgery is done using an endoscope placed in a small incision. An endoscope is small device with a light and a lens that allows the surgeon to view the Carpal Tunnel without disturbing the nearby tissues. The Endoscopic Carpal Tunnel Release spares some of the tissue in the palm; individuals may heal faster and experience less discomfort.
Following surgery, your incision will be wrapped in a soft dressing. Your physician may recommend that you wear a splint to provide support and promote healing. You will be able to move your fingers immediately after surgery. You will need to avoid heavy grasping or pinching motions for about six weeks. Your physician may recommend that you participate in occupational or physical therapy to gain strength, joint stability, and coordination. It may take several months for strength in the wrist and hand to return to normal.
Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take several months.