What is Carpal Tunnel Syndrome (CTS)?
Carpal tunnel syndrome (CTS) happens when the median nerve, one of the major nerves to the hand, is squeezed or compresses. The carpal tunnel is a passageway made up of tissue and bones. The aforementioned nerve runs through this tunnel at the wrist.
The carpal tunnel also houses flexor tendons which bend the fingers and thumb. This nerve also provides feeling in the thumb on the palm side and all fingers, apart from the little finger
If the flexor tendons and surrounding tissues (synovian tissues) swell, the carpal tunnel narrows and pressure is put on the median nerve. This common condition causes pain, tingling, weakness and numbness in the hand and arm. (1)
Women are three times more likely to develop this condition than men, particularly when pregnant. (2)
The symptoms of CTS are typically considered gradual and may also come and go. They are also more noticeable towards the end of the day However, as the condition worsens symptoms will be felt more frequently and for a longer duration.
Eventually symptoms will become present in the daytime, especially when carrying out activities with repetitive wrist movement. These include things like drawing, typing, sewing or playing video games.
Symptoms can also be attributed to certain professions where repetitive wrist movements are key. These include people who use computers for extended periods of time, construction workers who use tools that vibrate and assembly line workers. (3)
Sometimes there will be no apparent reason why symptoms start, although contributing factors can be: trauma or injury to the wrist, arthritis, thyroid issues or fluid retention and hormonal change during pregnancy.
The symptoms include:
Numbness and Tingling
This is usually the first sign of carpal tunnel syndrome and it can feel like pins and needles. Some people also report their hands and fingers feel swollen although there is no physical swelling.
You will lose some feeling in your fingers as well as the palm of the hand. This feels uncomfortable and painful, causing a burning sensation. Another possible sign is that you can find your fingertips feel cold to the touch.
The symptom tends to be more prevalent at night when you tend to sleep with your wrists flexed. (4,5)
It’s common for pain to be felt anywhere in the hand, fingers or wrist and can also travel up the arm to the shoulder. Dependent on how advanced the condition is the pain can be acute or chronic. (6)
Loss of Grip
Weakness and loss of strength, particularly in the thumb and fingers, are frequent complaints associated with this condition.
The median nerve controls sensory signals to the hand, thumb and fingers plus other muscles in that region. When it’s squeezed or compressed those signals don’t get transmitted properly.
This means if not treated, long term damage ensues and some of the muscles in the hand start wasting.
The result leads to difficulty with motor functions like picking up keys, pens, coins or other small objects.
With progression of the condition many other everyday tasks may also become harder to achieve. Using a toothbrush or cutlery, reading a book or gripping a steering wheel when driving can be difficult. (7)
There are three stages associated with this condition, all are classified according to the symptoms.
In the first stage waking during the night with a numb hand that feels like it’s swollen is typical. Pain can be chronic and travels from the wrist to the shoulder and there will be tingling in hand and fingers.
During the morning there can be a persistent sensation of stiffness in the hand. However, shaking the wrist can temporarily relieve the symptoms. (8)
When the condition reaches the second stage the symptoms linger during the day. They will also be present when the wrist and hand remain in the same position for prolonged periods.
Performing repetitive movements with the hand and wrist will intensify feelings of numbness, tingling and pain. Motor function can be impaired and there could be no feeling in the fingers causing loss of grip. (9)
In this final stage the muscles at the base of the thumb and in the palm of the hand have evident wastage. This results in weakness, loss of grip and motor functions.
Previous symptoms of tingling can reduce but tends to be replaced by aching in the palm and base of the thumb. Surgical intervention to relieve pressure on the nerve may not be successful if the compression is severe. (10)
The symptoms of carpal tunnel syndrome tend to get worse over time which is why early detection and treatment is paramount. The condition can be successfully addressed without the need for surgery if caught early enough.
The treatments include:
Splints worn at night stop you from bending your wrist while you are asleep. They hold the wrist in a straight or neutral position which helps reduce pressure on the nerve in the carpal tunnel.
There are also activities which can aggravate your symptoms during the day. In this case wearing a splint that extends your wrist backwards slightly will help.
A physiotherapist or occupational therapist will be able to assess and advice the best splint for you. (11)
Over the counter drugs can help relieve the symptoms of carpal tunnel syndrome. These include non-steroidal anti inflammatories like ibuprofen, aspirin or other pain relievers. The effects of these drugs help with pain in the short term but don’t treat the condition itself.
Prescription medications include oral or injectable corticosteroids.
These anti inflammatory drugs which help reduce pressure on the median nerve are injected into the carpal tunnel. However, the effects, whilst beneficial in reducing symptoms and flare ups, may only be temporary. (12)
Nerve gliding exercises help your nerves and move freely and normally. They are unable to do this when they are compressed or injured. Your physiotherapist or doctor can advise the best exercises for you based on your symptoms.
Interestingly, in some cases studies show nerve gliding exercises can actually negate the need for surgery. (13)
Certain daytime activities will irritate any symptoms you are experiencing. If this is the case avoid modifying or changing the way you do these activities. If it’s work related you can try taking regular breaks to rest the hand or try changing your work station.
Some alternative therapies have proved useful in relieving the symptoms of carpal tunnel syndrome. These include yoga, acupuncture and chiropractic manipulation.
Dependent on the severity and nature of your symptoms, surgical intervention may be the only option.
The surgical procedure is called a carpal tunnel release and aims to release the strain on the median nerve. The ligament is severed which leads to an increase in size of the carpal tunnel.
There are two methods of conducting this surgery, open carpal tunnel release and endoscopic carpal tunnel release.
Open surgery involves an incision being made into the wrist enabling access the ligament. Endoscopic surgery will use a small camera and cutting tool inserted through two small incisions to access the ligament. (18,19)
General or local anesthetics will be administered to carry out surgery, which in most cases is an outpatient procedure.
What is carpal tunnel syndrome (CTS)? Carpal tunnel syndrome happens when the median nerve is pinched. This nerve crosses through the tunnel, a rigid narrow passageway made up of ligaments and bones, at the wrist.
What are the signs of carpal tunnel syndrome (CTS)? Signs of this condition are tingling, numbness and pain in the hand and the first three fingers and thumb. They tend to be more noticeable at night but can continue into the day as the condition progresses. Loss of grip and an inability to grasp small objects can also occur.
How do you develop carpal tunnel syndrome (CTS)? A family history of the condition this could be passed on due to anatomical traits like a small carpal tunnel. Other risk factors are repetitive hand and wrist movements associated with certain jobs or activities. Some medical conditions can affect the size of the carpal tunnel and predispose you to this condition. These include arthritis, diabetes and thyroid gland imbalance. Pregnant women are also susceptible due to swelling as a result of water retention and hormonal changes. (20)
How are you diagnosed for carpal tunnel syndrome (CTS)? During your initial examination a doctor will ask about your symptoms and general health. A physical examination will identify weakness or sensitivity of the median nerve or wastage of muscles in the hand. Other imaging tests such as x-ray, ultrasound,CT scans or MRI scans may be done. (21)
What is the best treatment for carpal tunnel syndrome (CTS)? Whilst there are things you can do to relieve the symptoms of this condition surgery remains the best option. (22)
What are the long term complications of carpal tunnel syndrome (CTS)? If untreated carpal tunnel syndrome can lead to permanent damage of the median nerve. This will cause loss of grip, weakness and loss of feeling in the hand and fingers.
Is carpal tunnel syndrome (CTS) considered a disability? The condition is not considered a disability per se. However, there may be circumstances where you can qualify for social security benefits. (23)
Is there a cure for carpal tunnel syndrome (CTS)? Surgery is considered the gold standard treatment for carpal tunnel syndrome. The outcomes are positive in majority but not all cases. (24)
Is carpal tunnel syndrome life threatening (CTS)? This condition may cause discomfort and pain and it can interfere with your work and homelife. However it is not considered life threatening. (25)
We have learnt that carpal tunnel syndrome (CTS) is a neurological condition which happens when the median nerve is constricted or compressed. This nerve runs through the carpal tunnel at the wrist.
The symptoms generally worsen over time and include pain, tingling, numbness and loss of grip and feeling in the hand. However, on a positive note, there are treatments available of which surgery is the most successful.
Whilst there is no doubt this condition can interfere with everyday life, early detection is key to a favorable outcome.