What is Carpal Tunnel Syndrome?

     Carpal Tunnel Syndrome (CTS) is a common condition that causes pain, numbness, and tingling in the hand and arm. The syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers, excluding the little finger, and impulses to some small muscles in the hand that allow the fingers and thumb to move. When this nerve is compressed, it leads to the symptoms we associate with CTS.

How and Why Does Carpal Tunnel Syndrome Occur?

     CTS occurs due to pressure on the median nerve. This pressure can arise from swelling or anything that makes the carpal tunnel smaller. Several factors can contribute to the development of CTS. Certain conditions like diabetes, rheumatoid arthritis, or thyroid gland imbalance can predispose you to developing CTS. Hormonal changes, such as those experienced during pregnancy, can also lead to fluid retention and swelling in the tunnel.

     It is also often linked to activities that involve repetitive motion of the wrist, like typing, or the extended use of tools that vibrate or require a strong grip. However, it’s important to note that despite popular belief, there is limited scientific data to prove that these activities cause CTS. They may exacerbate the symptoms in individuals already predisposed to the condition, but they are not the primary cause.

Diagnosis of Carpal Tunnel Syndrome

     Diagnosing CTS starts with a thorough history of symptoms and a physical examination. Doctors may use provocative tests like the Tinel’s sign and Phalen’s maneuver. Electrodiagnostic tests, such as nerve conduction studies and electromyography (EMG), can help confirm the diagnosis by checking the median nerve’s functioning.

     Ultrasound or MRI imaging can provide a detailed view of the wrist and show whether the median nerve is compressed. In some cases, blood tests may be ordered to rule out conditions like diabetes and rheumatoid arthritis that can present with similar symptoms.

Non-Surgical and Surgical Treatment Options

     Treatment for CTS depends on the severity of symptoms and any underlying conditions that might be causing the symptoms. Non-surgical options are usually tried first. These can include:

Wrist splinting: A splint that holds your wrist still while you sleep can help relieve nighttime symptoms.

Nerve gliding exercises: Some people may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel.

Avoiding activities that worsen symptoms: If certain activities worsen symptoms, modifying or avoiding them can be beneficial.

Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter drugs like ibuprofen may help relieve pain and inflammation.

Corticosteroids: These can be taken orally or injected into the carpal tunnel to reduce inflammation and swelling.

     If non-surgical treatments do not relieve symptoms, surgery may be considered. Carpal tunnel release is one of the most common surgical procedures in the U.S. During this surgery, the transverse carpal ligament is cut, which relieves pressure on the median nerve and alleviates the symptoms of CTS. The procedure can be done as an open surgery or endoscopically with a smaller incision.

     While surgery can significantly improve symptoms and restore hand function, numbness and other symptoms may persist in some cases. Full recovery can take months, and therapy may be needed to regain wrist strength.

     Carpal Tunnel Syndrome is a common and treatable condition. If you’re experiencing symptoms, it’s essential to see a healthcare provider early to prevent permanent nerve damage. Non-surgical treatments often provide relief, but for severe cases, surgery may be required. With the right diagnosis and treatment, most people with CTS can find relief.