What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a condition caused by increased pressure on the median nerve within the wrist. It is a very common condition affecting the hand and arm. The median nerve provides feeling to the thumb, index finger, middle finger, and part of the ring finger. It also controls some small muscles at the base of the thumb. When the median nerve becomes compressed or squeezed, symptoms such as pain, numbness, tingling, or weakness may develop.

CTS typically occurs gradually, beginning with mild symptoms and progressively worsening if left untreated. Early intervention can help manage symptoms effectively and prevent permanent nerve damage.

What is the Carpal Tunnel?

The carpal tunnel is a narrow, rigid passageway located on the palm side of the wrist. This tunnel is formed by the wrist bones (carpal bones) on the bottom and sides and a tough band of connective tissue (the transverse carpal ligament) on top.

Within this tunnel, the median nerve and tendons of the fingers pass through. The tunnel provides limited space, and any swelling, inflammation, or irritation can cause increased pressure, compressing the median nerve and resulting in CTS.

What are the Symptoms of Carpal Tunnel Syndrome?

Common symptoms include:

•Numbness and tingling: Particularly affecting the thumb, index finger, middle finger, and half of the ring finger. It often feels like “pins and needles.”

•Pain and discomfort: Pain may radiate from the wrist into the hand, forearm, and sometimes up to the shoulder.

•Burning sensation: A common symptom that can disturb sleep, especially at night.

•Weakness in hand muscles: Difficulty gripping, dropping objects frequently, and struggling with tasks requiring fine motor skills, like buttoning shirts.

•Swelling sensation: Even though the hand isn’t visibly swollen, patients often feel as if the hand is swollen or heavy.

Symptoms usually start gradually, occurring occasionally at first, especially during sleep. Over time, these symptoms can become constant, causing discomfort throughout the day.

How Does Carpal Tunnel Syndrome Affect You?

CTS can significantly affect daily activities and quality of life. It can limit the ability to perform routine tasks at home or work, such as typing, writing, driving, or holding objects. Over time, if untreated, it may lead to permanent nerve and muscle damage, making simple tasks difficult or impossible to perform.

Chronic CTS can reduce grip strength and dexterity, impacting work performance, particularly for individuals whose jobs involve repetitive hand movements or prolonged wrist positions, such as typists, hairdressers, factory workers, and musicians.

When Should I See a Doctor About Carpal Tunnel Syndrome?

You should seek medical attention if you experience:

•Symptoms lasting more than a few weeks.

•Worsening numbness, tingling, or weakness.

•Disruption of daily activities or sleep.

•Progressive difficulty performing tasks that require fine motor skills.

Early intervention is crucial, as delays in treatment can lead to nerve and muscle damage that might be irreversible. Prompt diagnosis and management can alleviate symptoms and improve outcomes significantly.

Diagnosis of Carpal Tunnel Syndrome

Your doctor typically diagnoses CTS based on:

•Medical history: Discussion of symptoms, duration, severity, and activities that exacerbate symptoms.

•Physical examination: Specific tests, such as Tinel’s sign (tapping on the median nerve to trigger tingling) or Phalen’s test (holding wrists in flexed positions to provoke symptoms).

•Electrophysiological studies: Nerve conduction studies (NCS) and electromyography (EMG) may be used to confirm diagnosis and assess nerve damage severity.

Sometimes, imaging tests like ultrasound or MRI scans may be used to identify causes such as cysts or arthritis compressing the nerve.

Treatment Options for Carpal Tunnel Syndrome

Treatment depends on symptom severity and duration. The main goals of treatment are symptom relief, prevention of progression, and restoration of normal hand function.

Non-surgical Treatments

Lifestyle Modifications:

•Reducing or avoiding activities that aggravate symptoms.

•Regular breaks during repetitive tasks.

•Ergonomic workspace adjustments.

Splinting or Bracing:

•Wrist splints worn at night or during activities keep the wrist straight and reduce nerve compression. Splinting is effective in relieving early symptoms.

Medication:

•Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can reduce inflammation and relieve pain, though evidence of effectiveness for CTS specifically is moderate.

•Oral corticosteroids or steroid injections directly into the carpal tunnel area can provide temporary symptom relief by reducing swelling and inflammation.

Physical Therapy:

•Specific exercises to strengthen and stretch hand and wrist muscles can improve symptoms and prevent worsening.

•Therapists may also teach nerve-gliding exercises to help the median nerve move more freely within the carpal tunnel.

Alternative Treatments:

•Some patients find relief through acupuncture, yoga, or chiropractic care, although evidence supporting these is mixed.

Surgical Treatment

If symptoms are severe, persistent despite conservative measures, or if there is nerve damage, surgery may be recommended.

Carpal Tunnel Release Surgery:

This procedure involves cutting the transverse carpal ligament to relieve pressure on the median nerve. Surgery can be performed in two ways:

•Open Carpal Tunnel Release: A small incision in the palm is made to access and cut the ligament.

•Endoscopic Carpal Tunnel Release: A less invasive technique using small incisions and a camera (endoscope), resulting in faster recovery and less post-operative pain.

Surgery Outcomes:

•Surgery typically results in significant relief of symptoms, especially numbness and pain, and improvement of function in 70% to 90% of patients.

•Recovery varies from weeks to several months, with physical therapy often recommended to regain full strength and motion.

Prevention of Carpal Tunnel Syndrome

Preventative measures are essential, especially if you have risk factors (repetitive tasks, underlying medical conditions):

•Ergonomic work environment: Use supportive keyboards, mouse pads, and appropriate seating.

•Frequent breaks: Regularly pause from repetitive tasks to stretch and rest hands.

•Maintain neutral wrist position: Avoid prolonged wrist bending or extension.

•Exercise and stretches: Regularly perform exercises to improve hand strength, flexibility, and circulation.

Conclusion

Carpal tunnel syndrome is a common condition affecting millions, causing discomfort and impairment in daily tasks. Early recognition, prompt medical assessment, and appropriate intervention, ranging from simple lifestyle changes to surgery, can significantly improve outcomes and prevent long-term complications. If you experience persistent or worsening symptoms, it’s essential to consult your doctor promptly to discuss suitable management and treatment options tailored specifically to your needs.