Carpal Tunnel Syndrome (CTS). Symptoms and Treatment

Carpal tunnel syndrome (CTS) occurs when pressure is placed on your wrist's median nerve. The median nerve runs from your forearm into your palm, and it passes through the wrist in a small tube-like opening called the carpal tunnel. The carpal bones are the bones at the bottom of the carpal tunnel, while the carpal ligament is at the top.

What are the symptoms of Carpal Tunnel Syndrome?

Carpal tunnel syndrome affects the palm side of your hand, wrist, or forearm. The affected fingers include your thumb, index finger, middle finger, and the thumb side of your ring finger.

The symptoms in these areas can include numbness, tingling, pain, or burning. The symptoms are usually worse at night and can wake you from sleep. However, sometimes the symptoms are not noticed until the morning, upon awakening.

In addition, there can be weakness, including poor grip strength, with some patients reporting they drop items or have difficulty grasping things.

What are the risk factors for Carpal Tunnel Syndrome?

Repetitive use of an upper extremity, including your wrist or hands, is one of the leading causes of carpal tunnel syndrome, which occurs in certain workers.

However, there are other risk factors for carpal tunnel syndrome, including Type II diabetes mellitus, arthritic conditions like osteoarthritis or rheumatoid arthritis, a family history of CTS, obesity, a current or past wrist fracture, dislocation, aging, and some hormonal changes, like those during pregnancy or menopause.

Does gender affect my risk of developing Carpal Tunnel Syndrome?

It is well known that the CTS female to male ratio is three to one, meaning females are three times more likely to get CTS. However, evidence now suggests it may be due to the larger percentage of females performing repetitive tasks at work, like keyboarding. When the occupational risks were similar, the incidence of CTS was equivalent.

How is Carpal Tunnel Syndrome diagnosed?

CTS is diagnosed by a combination of history, physical exam findings, laboratory plus imaging studies to rule out other conditions that mimic CTS, and electrodiagnostic tests that can confirm the diagnosis.

Physical examination and X-rays:

For evaluation of CTS, your neck, shoulder, and upper extremity must be examined. In addition, any tenderness of the areas mentioned above promotes the need for X-rays to evaluate the underlying bones for abnormalities such as a fracture (break), bone cyst (a fluid-filled sac), spurs (a bony prominence), or arthritis.

Specific physical exam tests exist for CTS, including Tinel's and Phalen's tests. Tinel's test involves tapping over the median nerve to see if any symptoms are present, such as numbness, tingling, or pain. For Phalen's test, the top of the hands, called the dorsum, are placed together for 30 to 60 seconds to see if similar symptoms are produced.

Laboratory tests:

Laboratory tests can assist in determining if a more serious condition is present. For example, an erythrocyte sedimentation rate (ESR) checks for inflammatory diseases. In addition, for rheumatoid arthritis, an antinuclear antibody (ANA) and rheumatoid factor (RF) should be checked.

Other diagnostic tests:

A nerve conduction test can precisely evaluate the function of the median nerve and determine the degree of damage. In contrast, an ultrasound can determine if there is swelling at the carpal ligament.

How is Carpal Tunnel Syndrome treated?

The treatment of carpal tunnel syndrome varies depending on several factors, including age, severity, causes, etc. Therefore, every person with CTS is different and can respond differently to types of treatments.

A wrist brace (splint) is usually the first-line treatment of carpal tunnel syndrome, especially worn at night when the carpal tunnel becomes compressed. In addition, a wrist brace pushes the palm slightly backwards. When worn during the day, it can be enough to relieve the CTS symptoms. Wrist braces can be fabricated (made ahead of time) or custom-made.

Medications can relieve CTS symptoms and include over-the-counter (OTC) pain medications such as acetaminophen (Tylenol). However, use it cautiously since excessive use can lead to liver disease.

Nonsteroidal anti-inflammatory drugs, known as NSAIDs, taken as a prescription or over the counter, can help with inflammation, swelling, and chronic pain. However, caution is recommended with NSAIDs since there is a risk of gastrointestinal (GI) irritation, causing stomach ulcers and bleeding.

Corticosteroids, such as oral prednisone, or other injectable intramuscular systemic steroids, can help in some cases.

Activity changes can be the most straightforward treatment of CTS by eliminating the activity that causes the CTS. If it is work-related, an ergonomic evaluation can be beneficial, in addition to regular breaks in the causal action.

Ice or heat can be helpful.

Physical therapy (PT) and occupational therapy (OT) can help, especially if there is poor posture or body mechanics (function). The therapist can assist with exercises for stretching and strengthening. In addition, they can help you with modalities including electrical stimulation, ultrasound, ice/heat, etc.

Direct cortisone injection into the carpal space has provided relief for many patients.

Alternative treatments such as chiropractic and acupuncture have shown to be successful in symptom relief.

Surgery is recommended when the above methods have not provided significant relief. This can be done with the traditional open release method or with the use of a scope.