Carpal Tunnel Syndrome (CTS) happens because of increased pressure on the median nerve at the wrist, leading to a range of symptoms, including numbness, tingling, and weakness in the hand. At the level of the wrist, the median nerve travels through a tunnel formed by the wrist bones on the bottom and sides, and a thick ligament across the top. The median nerve controls sensation in the thumb, index, and middle fingers, as well as the function of the muscles at the base of the thumb.
Primary Causes of Carpal Tunnel Syndrome
Carpal Tunnel Syndrome can be caused by a variety of factors. A common cause is activities involving repetitive use of fingers and hands. In particular, activities that involve high levels of force, prolonged use, extreme wrist motions, or vibration can lead to or worsen CTS.
Other factors contributing to the development of CTS include:
- Anatomical Factors: Genetics may determine the size of the bony structures that comprise the carpal tunnel, predisposing some individuals to CTS. Also, prior wrist injuries, including fractures, dislocations, or arthritic changes can reduce the size of the carpal tunnel, resulting in CTS
- Gender: CTS is more common in women, possibly due to the relatively smaller carpal tunnel size compared to men.
- Nerve-damaging Conditions: Chronic illnesses, such as diabetes mellitus, can result in nerve damage, including damage to the median nerve.
- Inflammatory Conditions: Chronic inflammatory diseases, such as rheumatoid arthritis, can affect the wrist tendons, thereby causing CTS.
- Obesity: Being obese is a risk factor for CTS.
- Body Fluid Shifts: Fluid retention can increase the pressure within the carpal tunnel, irritating the median nerve. This is common during pregnancy, breastfeeding, and menopause.
Symptoms of Carpal Tunnel Syndrome
The symptoms of CTS typically start gradually and can occur at any time. Early symptoms often include numbness, tingling, and/or pain in the fingers, particularly at night. These symptoms can also occur while holding a steering wheel, phone, or newspaper.
As CTS progresses, symptoms worsen and become more constant. These symptoms can include:
- Weakness and dyscoordination: This can lead to difficulty with gripping activities and a tendency to drop objects.
- Shock-like feelings that move into your fingers.
- Numbness or tingling that radiates up the arm.
If left untreated, CTS can lead to permanent nerve and muscle damage. Therefore, it is crucial to see a healthcare provider if you observe any symptoms of CTS that interfere with your normal activities and sleep patterns.
Diagnosis of Carpal Tunnel Syndrome
The diagnosis of CTS is often made based on the patient’s history of symptoms and a physical examination. During the physical exam, the doctor may perform sensation testing on the palm and back of the fingers and hand. He or she may also test the function of muscles in the hand and arm.
Electrodiagnostic studies (NCS & EMG) may also be used to confirm the diagnosis. These studies provide information about how well the nerves and muscles are working and can help identify other causes of symptoms.
Non-Surgical Treatment for Carpal Tunnel Syndrome
The primary goal of treatment is to reduce or eliminate the symptoms caused by increased pressure on the median nerve. Some non-surgical treatment options include:
- Oral anti-inflammatory medicine
- Steroid injection (cortisone shot)
- Wrist splint(s)
- Vitamin supplements
These treatments are most effective when symptoms have only been present for a few months.
Surgical Treatment for Carpal Tunnel Syndrome
Surgery is generally recommended when symptoms have been present for an extended period of time, or when conservative management does not provide relief. The surgical procedure performed for CTS is called a carpal tunnel release. The goal of this procedure is to relieve pressure on the median nerve by cutting the ligament that forms the roof of the tunnel. This relieves the pressure on the median nerve, and generally results in complete resolution of symptoms.
Recovery After Carpal Tunnel Surgery
Immediately after surgery, you will be encouraged to elevate your hand above your heart and move your fingers to reduce swelling and prevent stiffness. Light activity is generally allowed, including writing, typing, or using a cellphone. Most patients experience relief of their nighttime symptoms within the first week or two. However, some patients experience swelling, stiffness, or hypersensitivity, which can last several weeks to several months. Most patients find that they are able to resume about 80% of their usual activities within three weeks of surgery.
Grip and Pinch Strength after Surgery
Grip and pinch strength usually return about 2 to 3 months after surgery. However, most patients find that their ability to perform their day-to-day tasks has returned long before this time. In some cases of severe or prolonged CTS, grip and pinch strength may never fully recover.
Numbness and Tingling after Surgery
Many patients experience improvement in their sensation within the first few days of surgery. However, in severe or prolonged CTS, sensation may take 6 to 12 months to improve.
Although there are risks with any type of surgery, your doctor will take steps to minimize these risks. The most common complications of carpal tunnel release surgery include bleeding, infection, wound healing issues, and nerve aggravation or injury.
When needed, surgery is an effective way to improve the symptoms of carpal tunnel syndrome. Most patients find that the operation and recovery are very manageable, and many wish they had undergone the procedure earlier,
Preventing Carpal Tunnel Syndrome
While there are no proven strategies to prevent CTS, you can minimize stress on your hands and wrists by reducing your force and relaxing your grip when possible and by taking short, frequent breaks. Some people benefit from ergonomic modifications or wearing wrist splints.
Carpal Tunnel Syndrome is a common condition that can cause significant discomfort and disability if not treated promptly. Understanding the symptoms, causes, and treatment options can help you manage this condition effectively. If you are experiencing symptoms of CTS, it is crucial to consult with a healthcare provider for an accurate diagnosis and treatment plan. With proper intervention, most people with CTS can find relief and regain normal hand function.