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 dysfunction of the nerve. Approximately 3-6% of the population suffers from Carpal Tunnel Syndrome (CTS), with the conditions affecting the elderly and women (including pregnant women).
Figure A: Shows the median nerve (dotted lines) deep to the carpal tunnel ligament.
Patients usually experience a sensation of “pins and needles” at the fingertips, particularly towards 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 up a shirt, holding a cup, pinching and gripping actions may be difficult to accomplish.
Repetitive activities of the wrist, such as typing, driving, reading the newspaper, holding a phone and using chopsticks could possibly bring on CTS. In some instances, there may be pre-existing conditions, hereditary or otherwise, that influence how prone you are to developing CTS. There are certain cases where CTS is caused by a change in your physical health. For example, pregnancy is a leading cause of CTS because of hormone imbalances. Other conditions associated with CTS include a tumour in the carpal tunnel canal, diabetes mellitus, hypothyroidism, menopause, pregnancy, renal failure, Raynaud’s syndrome, repetitive strain injuries and double crush syndrome (Osterman,Lancet, 1991).
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.
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:
| factors present | non-operative suscessful rx |
|---|---|
| 0 | 66% |
| 1 | 59% |
| 2 | 16.7% |
| 3 | 6.8% |
| ≥4 | 0% |
Source: Kaplan, Glickel, Eaton ( J Hand Surg 1990 )
Nerve compression is the main cause of both carpal tunnel syndrome and cubital tunnel syndrome. The difference between these two deceptively similar conditions lies in the location of the damaged nerve.
While both conditions affect the fingers and hands, the nerves are different. People feel the pain of CTS the most in the thumb and first three digits. It is also usually accompanied by mild to intense burning sensations which radiate across the hand and up the wrist and arm.
In contrast, the fingers afflicted by Cubital Tunnel Syndrome include the last two digits: the little and ring fingers. Sufferers usually report pain in their inner hand as well. Symptoms can worsen at night, especially if the sufferer tends to bend their elbow while asleep.
Exercise alone might not be able to relieve CTS-related pain. The exercise would be more effective if combined with a modest lifestyle and behavioural changes.
Try to lightly strike the median nerve at the inside of your wrist. If it causes numbness or a pins-and-needles sensation, that is called Tinel's sign and may indicate CTS.
We recommend you seek medical advice when the symptoms occur persistently. Early diagnosis could prevent irreversible damage to your muscle and nerves.
Another test is to put consistent pressure on the same median nerve location. After around 20 seconds, there may be similar painful sensations in your fingertips. This is called the Durkan Test and again may indicate the presence of CTS.
Not sure if you’re experiencing signs and symptoms of carpal tunnel syndrome? Speak to our hand care team to find out if this is the medical condition you have at +65 6733 9093. Or book an appointment with our hand specialists for a consultation on your symptoms and treatment options.
