Carpal Tunnel Syndrome (CTS)

The carpal tunnel is a narrow passageway in the wrist that allows the tendons and nerves of the hand to pass through unobstructed. Carpal Tunnel Syndrome or CTS occurs when pressure is placed on the median nerve at the wrist, usually due to congenital factors or injury.  When the median nerve is compressed, numbness, tingling sensations and weakness in the hand, especially at the index finger and thumb, can occur.

Causes of CTS

CTS is caused by inflamed ligaments and tendons or any other swelling or structural problems that narrow this passageway. Typically, nerve involvement is a symptom rather than a cause of the dysfunction. Trauma, injury, pituitary or thyroid gland dysfunction and rheumatoid arthritis can all contribute to CTS. Repetitive use of the wrist can also increase the risk of CTS.

CTS was once thought to be purely a repetitive motion issue; however, it has become increasingly clear that congenital predisposition plays a large part in the size of the carpal tunnel and the risk of eventually developing CTS.

Women, those with diabetes, manual laborers and assembly line workers all have a higher risk of developing carpal tunnel syndrome.

Signs and Symptoms of CTS

The symptoms of CTS are usually distinct and pronounced. They typically begin as mild with some numbness and tingling in the thumb, index and middle fingers. Some describe the sensation as that of a swollen finger, though no overt swelling is visible. In earlier stages, the signs usually occur in the evening or nighttime. The patient’s dominant hand is usually affected first. Over time, symptoms worsen, and the numbness and tingling will be felt during the day.  Over time, they will become more pronounced with certain activities like talking on the phone or driving. Longer-term, manual function may be compromised, and patients may find it difficult to hold small objects. If CTS is allowed to progress untreated, patients may have problems with their sensations and not be able to differentiate between hot and cold.

Diagnosis and The Treatment Plan

If not treated in its earlier stages, some of the dysfunction associated with carpal tunnel syndrome may become permanent. As such, it is important to speak to a qualified orthopedic surgeon to learn more.

• During consultation, patients will have a full physical evaluation including sensation in the fingers and evaluation of the wrist
• Diagnostic testing including x-rays and bloodwork can rule out other possible causes of the symptoms, such as a fracture in the wrist or type-2 diabetes
• A Tinel’s Sign test can help confirm the diagnosis of CTS. During this test, your doctor taps on the median nerve which, when positive, will send an electric like sensation into the fingers
• The Phalen’s Maneuver, which involves pressing the back of the hands together with the fingers pointing down also suggests carpal tunnel syndrome when patients feel increased tingling or numbness within a minute
• Nerve conduction studies and electromyography can also be used to better understand the how electrical impulses travel along the median nerve and through the carpal tunnel
• Ultrasound can be utilized to visualize the structures of the wrist
• And while an MRI may have some value in eliminating or confirming other possible causes of dysfunction, it is not useful in diagnosing CTS

Treatment for CTS

With early identification and treatment, many patients can start with conservative measures such as lifestyle change, better management of diabetes, splinting the wrist, avoiding certain activities, taking anti-inflammatory medication, physical therapy and trying complementary therapies like yoga.

For more severe cases, or for those that have not seen improvement with conservative treatment, carpal tunnel release surgery is an effective and safe procedure for long-term relief of CTS. Carpal tunnel release surgery may be performed in the traditional open manner with a longer single incision or endoscopically using one or two very small incisions. During this procedure, the ligament above the carpal tunnel is cut to release pressure on the nerve. Learn more about carpal tunnel release surgery.