What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is a very common neurologic problem where one of the main nerves supplying the hand gets compressed at the wrist.  There is a build-up of pressure in the carpal tunnel which results in dysfunction of the nerve. This nerve, known as the median nerve, is the primary supplier of sensation to the thumb, index and middle fingers, as well as a portion of the ring finger.  It is also the nerve which controls the thumb muscles, which are vital for grasping and pinching and overall hand function.

What are the symptoms?

The most common symptoms of CTS are numbness and tingling in the hand and fingers.  A sensation of pins and needles is often reported, usually affecting the thumb, index and middle fingers, but not always.  Symptoms often occur at night time, and can wake you from sleep. Shaking out the hands can provide temporary relief. In addition, some patients complain of pain in the wrist that can radiate up to the elbow.  It can affect both hands simultaneously. There may be associated weakness, which can result in dropping objects, and can also result in loss of dexterity. This may be noted as an increased difficulty performing fine motor tasks, and can even affect hand writing.  

How is carpal tunnel syndrome diagnosed?

The diagnosis of CTS is almost always made clinically, typically after a thorough medical history and physical examination.  Certain exam findings can be very diagnostic, such as altered sensation in the thumb, index and middle fingers when compared to the small finger.  In addition, pain can be elicited with direct pressure over the palm and wrist, as well as a Tinel’s sign. This is when the palmar aspect of the wrist is tapped resulting in an electric type sensation shooting into the fingers.  Another helpful exam finding is reproduction of the symptoms when the wrist is placed in full flexion or extension for a period of 30 seconds or more. Electrodiagnostic testing, such as an EMG (electromyogram) and NCS (nerve conduction study) may be utilized in conjunction with the clinical findings to help confirm the diagnosis, but also to stage the severity.  These tests can provide information that is useful in deciding appropriate treatment. X-rays, Cat Scans and MRIs are not typically useful in the diagnosis of CTS, and are not usually used during the workup.

What are the risk factors?

Several risk factors have been correlated with CTS.  The common ones include, but are not limited to, female gender, older age, diabetes, hypothyroidism, rheumatoid arthritis, pregnancy, smoking and alcohol abuse, certain repetitive activities, and previous injuries.

What is the treatment?

Carpal tunnel syndrome can be a difficult problem that gets in the way of daily activities and quality of life.  Unfortunately, CTS doesn’t usually go away, and typically gets progressively worse over time. It is important to speak with your doctor about these symptoms if you are experiencing them on a regular basis.  There are many effective treatments available, and their success correlates to an early and accurate diagnosis. In mild cases of CTS, the treatment is night wrist splinting. Many of us sleep with our wrist and hands curled and clenched, which is unfortunately not ideal for the median nerve.  By keeping the wrists straight, it decreases the pressure on the nerve, allowing it to function better and minimize the symptoms listed above. CTS can also be treated with steroid injections. Although these injections can provide significant relief, they do not typically cure the problem. For patients who have not had success with non-operative treatment, carpal tunnel release surgery is the last option.  During the surgery, the ligament which forms the roof of the carpal tunnel in the wrist and palm, is released which creates abundant space for the nerve beneath it. Traditionally, this was performed with an open incision in the palm, but more recent techniques allow a specially trained Hand Surgeon to perform this procedure endoscopically. This is a much less invasive option, with a smaller scar and less pain after surgery, as well as a speedier recovery.  The results of carpal tunnel release surgery are excellent in the appropriate individual.