Carpal Tunnel Syndrome

What Is It?

Carpal Tunnel Syndrome (CTS) is a chronic painful condition of the wrist area. It is often caused by the compression of the median nerve in the ligaments of the wrist, resulting in the dysfunction of the nerve. The main cause of the condition is thought to be swelling of wrist tendon linings that results in overcrowding of the carpal tunnel.

Signs & Symptoms

Image of Signs & Symptoms

Figure A: Figure showing the median nerve (dotted lines) deep to the Carpal tunnel ligament.

Patients usually experience a sensation of “pins and needles” at the fingertips, particularly to the thumb, index, and middle finger. There may also be feelings of tightness at the wrist area.

In severe cases, patients may experience pronounced numbness (decreased sensation) and pain, and therefore, have problems sleeping at night. Simple daily tasks may prove challenging as hands become clumsier. Buttoning of shirt, holding a cup, pinching and gripping actions may be difficult to accomplish.

Causes

Repetitive activities of the wrist, such as typing, driving, reading the newspaper, holding the telephone receiver and using chopsticks could possibly bring on CTS. Other conditions associated with CTS include a tumour in the carpal tunnel canal, diabetes mellitus, hypothyroidism, menopause, pregnancy, renal failure, Raynaud’s Disease, repetitive strain injuries and Double Crush Syndrome Osterman (Lancet, 1991).

Diagnosis

An accurate medical history and clinical examination are usually sufficient for your doctor to make the diagnosis. Your doctor may order X-rays if a bone problem is thought to be a possible cause. Nerve conduction studies, either alone or with electromyography (EMG), may be necessary in severe cases or when a more proximal compression site is suspected.

Treatment Options

Mild symptoms of CTS can be treated with modest lifestyle changes and activity modification, accompanied by oral medication and the application of a wrist splint. If symptoms persist, you may need surgery.

Your doctor will advise you if your condition suggests a surgical intervention. Factors to consider:

  • Age over 55 years
  • Duration over 10 months
  • Constant paresthia
  • Stenosing flexor tenosynovitis
  • Phalen’s test positive < 30 seconds

Image of Source: Kaplan, Glickel, Eaton (J Hand Surg 1990)
Source: Kaplan, Glickel, Eaton (J Hand Surg 1990)