Carpal tunnel syndrome (CTS) is one of the most common causes for pain in the U.S.It is marked by numbness and tingling in the hand, caused by compression of the median nerve as it travels through the wrist. Women are, at least, twice as likely to be affected as men.
Pain, numbness and tingling usually occur on the palm and palmar side of the first three fingers from the thumb. Weakness can, also, occur in the thumb and adjacent fingers. Symptoms are aggravated by the position of the wrist, and are usually occur at night, after a long day of use. They may radiate up the arm as far as the shoulder, too. Other symptoms can include decreased dexterity, a weak grip, atrophy of muscles in the hand, and feelings of hand swelling.
Common causes and predisposing factors for CTS include:
- Repetitive strain and prolonged flexion/extension of the wrist, notably from activities such as driving, reading, typing, and holding a telephone
- Rheumatoid arthritis
- Diabetes
- Wrist fracture and associated swelling
- Pregnancy/oral contraceptive use leading to swelling in the limbs
- Underlying nerve dysfunctions
Diagnosis and Treatment
A physician may perform a variety of tests and nerve conduction studies to confirm the diagnosis.
The goal of treatment is to reduce pain, numbness and tingling, and prevent loss of motor function. Treatment depends on the severity of CTS and patient preference. Most mild to moderate cases of CTS can be effectively managed with a combination of conservative treatments:
- Minimizing contributory factors such as repetitive use/strain
- Wrist splinting helps keep the wrist in a neutral position, limiting prolonged extension/flexion
- Glucocorticoids (steroids) can be taken orally or injected into the carpal tunnel to reduce inflammation and compression
- Deep, pulsed ultrasound can be used to decrease pain and promote soft tissue healing
Yoga has been shown to be effective for pain control
For symptoms that do not improve within 6 months of conservative treatment, surgical decompression of the median nerve may be necessary. Surgical intervention is generally more effective than conservative treatments. Improvement is seen in, approximately, 85-90% of cases. Surgical treatments include open incision or endoscopically:
- An open release is performed via standard incision under local anesthesia, and allows a surgeon the best view
- An endoscopic release is performed with scopes and surgical tools through one or two small openings, and can result in less scar tissue and post-operative pain
The prognosis for CTS is good, although a minority of patients, particularly those with advanced CTS, may fail to improve after treatment. Additionally, scarring post-surgery can lead to a recurrence of symptoms, even months or years later. The best way to treat CTS is to practice ergonomically appropriate habits at home and at work, to avoid repetitive tasks previously, and to keep wrists in a neutral position as often as possible.
References
- Wrist Anatomy– PainDoctor.com
- Carpal Tunnel Syndrome– PainDoctor.com
- Scherger, J.E.; et al. (2007). Carpal tunnel syndrome. First Consult. MD Consult Web site, Core Collection. Retrieved from
- Scott, K.R.; Kothari, M.J. (2011). Treatment of carpal tunnel syndrome. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- Hunter, A.A.; Simmons, B.P. (2010). Surgery for carpal tunnel syndrome. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.