Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a condition in which the median nerve and the tendons that bend the fingers and the wrist become compressed, leading to pain, numbness and tingling in the fingers. The median nerve and the tendons pass through the carpal tunnel, a narrow, rigid tube of ligament and bones at the base of the hand. CTS can cause discomfort and interfere with everyday activities.

The exact cause of CTS is unknown. It may result from a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel rather than a problem with the nerve itself. Sometimes, irritated tendons can thicken or swell, narrowing the tunnel and compressing the median nerve. In many cases, no single cause can be identified.

Environmental factors, such as trauma or injury to the wrist, may contribute to the development of CTS. A sprain or fracture that causes swelling may lead to mechanical problems in the wrist joint, as can repeated use of vibrating machinery. Certain medical conditions, such as problems with the pituitary or thyroid gland, rheumatoid arthritis or other autoimmune diseases and diabetes or other metabolic disorders, can make the body’s nerves susceptible to compression. Additionally, women may experience fluid retention during pregnancy, menopause, and certain phases of the menstrual cycle, which leads to CTS.

Carpal Tunnel Syndrome is a common nerve condition. Anyone can get it, but it usually occurs in adults. Women are more likely than men to develop it. While age and gender may play a role in developing CTS, adopting healthy habits may help prevent it. One way to do this is to identify potential ergonomic changes you can make at home or at work that can reduce symptoms.

To help prevent carpal tunnel syndrome, it is important to take frequent breaks from repetitive activities, practice proper posture and body mechanics when performing tasks that use the wrist, keep wrists in a neutral position while typing or writing, stretch the wrists and hands regularly, wear correct ergonomic equipment when performing tasks that require repetitive motions, and maintain a healthy weight.

Symptoms of carpal tunnel syndrome include pain or tingling in the thumb, index finger, middle finger and half of the ring finger. The pain may start in the wrist and travel up the arm. It can be worse at night when performing repetitive motions such as typing, writing or gripping small objects.

Symptoms usually start slowly and first appear in one or both hands at night but go away during the day. You may feel numbness, weakness or tingling in your fingers, or they may feel swollen and cold. You might wake up and need to “shake out” your hand or wrist.

As symptoms worsen, you might feel symptoms during the day, especially with certain activities requiring you to use your wrist and hand. These may include talking on the phone, reading a book or newspaper, or driving.

In chronic (long-term) or untreated cases, the fingers can feel numb all the time, and you may have difficulty grabbing small objects, such as buttons and zippers. The muscles at the base of the thumb may also become so weak that it becomes difficult or impossible to grasp small objects.

When diagnosing carpal tunnel syndrome, your doctor will ask about your medical history and symptoms. They may also perform a physical exam and order nerve conduction tests to measure how well the nerves in your wrist are working. Imaging tests, such as X-rays, ultrasound or magnetic resonance imaging (MRI), can be used to rule out other causes of the symptoms.

Early diagnosis and treatment are essential to avoid further damage to the median nerve. To see if you have CTS, your doctor may perform the following assessments:

• Physical exam: Most cases of CTS can be diagnosed with a physical exam. Your doctor will examine your hands, arms, shoulders and neck to help determine if your symptoms are related to daily activities or another disorder and to rule out other causes. Your wrist will be examined to see if tapping or pressing on your median nerve or flexing your wrist causes a numbing or tingling sensation. Your doctor will test your fingers for sensation and the muscles at the base of your hand for strength and signs of atrophy or weakening.
• Laboratory tests and X-rays: Sometimes, your doctor may order laboratory tests and X-rays to find fractures, arthritis or nerve-damaging diseases like diabetes.
• Tests using electric signals: Sometimes, where a physical exam alone is insufficient to diagnose CTS, your physician may order other tests, including the following:
  • A nerve conduction study: This assessment measures how quickly signals are transmitted along a nerve to see if the signals are slowed down at the carpal tunnel.
  • Electromyography: This exam can determine the severity of muscle damage due to the CTS.
  • Ultrasound: This scan can be used to see if the median nerve is swollen at the carpal tunnel.

Treatments for CTS should begin as soon as possible. You should first work with your care team to treat the underlying causes, such as diabetes or arthritis. Carpal tunnel syndrome is usually treated by one of the following specialists:

• Neurologists diagnose and treat nerve disorders.
• Neurosurgeons specialize in the diagnosis and surgical treatment of peripheral nerve disorders. 
• Orthopedic surgeons diagnose and treat injuries to bones, joints, ligaments, tendons, muscles and nerves.
• Primary health care providers, including family doctors, internists and rheumatologists, treat problems as they arise and coordinate care between specialized providers.
• Occupational and physical therapists teach ways to strengthen muscles and joints, minimize pain and perform activities of daily living.
• Pain management specialists are physicians trained in the evaluation and treatment of pain.
• Physiatrists are doctors who specialize in nonsurgical management of musculoskeletal conditions and can develop a plan of care, including rehabilitation.

Nonsurgical Treatments
Nonsurgical treatments can improve the symptoms of CTS in the short term, but they do not treat the underlying problem with the median nerve or lead to long-term symptom improvement. Splinting or bracing the hand and wrist at night is a standard initial treatment option for CTS symptoms. Additionally, steroid injections into the carpal tunnel can temporarily alleviate symptoms of CTS. 

Surgical Treatments
Carpal tunnel release is one of the most common surgical procedures in the United States. It involves making a small incision and cutting a ligament (the tissue that holds joints together) to relieve the pressure on the median nerve. Some people with CTS may need surgery on both wrists. There are two different methods of carpal tunnel release surgery:

• Open-release surgery is the traditional procedure for correcting CTS. A surgeon makes an incision in the wrist and then cuts the carpal ligament to enlarge the carpal tunnel. The procedure is generally performed under local anesthesia on an outpatient basis. 
• Endoscopic surgery involves one or two small incisions in your wrist and palm. A camera attached to a tube is then inserted to examine the nerve, ligament and tendons on a monitor. Using the image as a guide, the surgeon cuts the carpal ligament with a small knife inserted through the tube. This surgery may allow faster recovery and cause less discomfort than traditional open-release surgery. However, it also carries a higher risk of complications and an increased need for repeat surgery.

Although carpal tunnel surgery may quickly relieve symptoms, full recovery depends on the severity of the CTS and can take months to years. All surgeries carry risks. Some people may experience infections, nerve damage, stiffness or pain at the scar. Surgery usually solves the issue permanently, and it is very rare for carpal tunnel syndrome to come back after surgery.

There are many things you can try to help you manage early carpal tunnel syndrome symptoms and relieve pain, including:

• Minimizing repetitive movements 
• Resting your hands periodically 
• Seeking medical care when you need it 
• Taking medications as prescribed by your doctor 
• Taking short breaks when doing repetitive tasks with your hands
• Using ergonomically designed tools and furniture when possible
• Using ice packs as needed 
• Wearing a splint on your hand and wrist at night