About Carpal Tunnel Syndrome (CTS)

Carpal Tunnel syndrome (CTS) is essentially a pinched nerve in the hand. More accurately, CTS refers to a condition that causes compression of the median nerve at the hand and wrist. There are various causes of this, however they all result in the classic symptoms of pain, tingling and numbness in the hand and fingers.

General Information

The median nerve and several tendons travel through your forearm to your hand through a small compartment in your wrist called the carpal tunnel. The median nerve controls movement and sensation or feeling in your thumb and index, middle and ring fingers. Carpal Tunnel Syndrome is a condition in which there is increased pressure on the median nerve. Because the carpal tunnel is a relatively inelastic compartment, the nerve becomes painfully compressed. This pressure can come from edema, inflammation, or thickening of the structures that form the tunnel, thereby limiting the space for the median nerve. The resulting pressure on the nerve causes the symptoms of pain and numbness. Commonly, repetitive hand movements, especially with the wrist bent down (example: typing), or making the same wrist movements over and over again are the contributing factors to CTS. The incidence of CTS is higher in association with certain underlying conditions, such as hypothyroidism, rheumatoid arthritis, diabetes and obesity. Pregnancy may also be a cause from general tissue swelling. Other conditions that compromise the space within the carpal tunnel are wrist injuries and bone spurs. CTS is seen more frequently in smokers, thought to be a result of reduced blood flow to the median nerve.

Signs & Symptoms

Carpal tunnel syndrome can cause tingling, numbness, weakness, and often pain in the fingers and hand. You may also experience radiating pain up the arm to the elbow. Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. Therefore, if you have problems with all fingers except your little finger, it may be a sign that you have carpal tunnel syndrome. The median nerve does not provide sensation to the little finger. Driving and typing often cause pain, due to the bent wrist position, which creates pressure on the nerve. Symptoms may be quite prevalent at night. Nocturnal paresthesias, or numbness and tingling at night, is the classic symptom of CTS. Shaking your hand may provide temporary relief of symptoms. Awakening at night to shake the feeling back into your hand is very common invariably CTS.

Diagnosis/Understanding the Problem

The diagnosis of this condition begins with a physician obtaining a thorough history of any potentially predisposing medical diagnoses such as hypothyroidism and diabetes. A social history of possible issues such as smoking, or occupational history of repetitive movements such as typing are predictive factors. A physical exam focuses on any visible atrophy (muscle loss) in the palm, and specific tests for loss of sensation in the hand or fingers. Tapping on the carpal tunnel at the wrist (Tinnel's Sign) or producing symptoms of carpal tunnel by keeping your wrist in a bent position for a prolonged period (Phalen's Sign) are often utilized to diagnose this condition. A nerve conduction test (EMG) may also be ordered to confirm the diagnosis of CTS . Other conditions that may mimic CTS pinched or compressed nerves in the arm, shoulder or neck. A nerve conduction study will help to differentiate these causes of pain.

Nonsurgical Treatments

Treatment for carpal tunnel syndrome most often begins with activity modification. Although permanent damage is rare, the sooner you treat the condition the more likely you are to avoid long-term injury to the median nerve. Avoiding activities that provoke symptoms is very important. If avoidance of such activities is impossible, you should at least attempt to give yourself breaks or periods of rest during the activities that produce symptoms. NSAID's, oral or topical, vitamin supplements, periodic sessions of ice to the wrist and wrist splints are mainstays of treatment. An exercise program consisting of carpal ligament stretching and strengthening of the hand and wrist musculature are important to decompress the carpal canal. Wearing a wrist splint is usually helpful. A wrist splint is a brace that maintains the wrist in a neutral position. The neutral position is that in which the median nerve is under the least amount of pressure. Wrist splints are used day and/or night. The wrist splint is worn long enough to control symptoms. This might be all day long or just during activities that produce symptoms. For those who experience night pain, the brace is generally worn throughout the night while sleeping.

The goal of each of these treatment methods is to attempt to relieve the stress or inflammation on the median nerve. The treatment options listed in the following OrthoKit focus on this goal:

• Carpal Tunnel Splint
• Isotoner Glove
• Putty/Band/Exerciser
• Topical Gel
• Rehab Program
• Vitamin B Supplement

Surgical Treatment

For those patients who have exhausted all possible non-surgical treatment options and symptoms of carpal tunnel syndrome persist, there is a definitive surgical option. The procedure is known as a Carpal Tunnel Release. A structure in the hand known as the transverse carpal ligament is largely responsible for compression on the median nerve. A carpal tunnel release involves a surgeon making a small incision at the juncture of the palm and wrist and carefully releasing, or making a small cut through, the transverse carpal ligament. Careful attention is taken to protect the median nerve throughout this procedure. In this way, the carpal tunnel is decompressed, which relieves pressure on the median nerve and opens the path it travels along the wrist into the hand. This is a delicate though minor procedure that takes about 20 minutes. The recovery is relatively easy. A period of rest and avoidance of certain activities is required for a few weeks and full recovery is expected in about one month.