Carpal Tunnel Syndrome (CTS)

What is Carpal Tunnel Syndrome?

This is a very common problem and represents the most common example of a class of conditions known as entrapment or compression neuropathies. Simply said, this means that the symptoms are the result of abnormal pressure on a particular nerve. In this case the nerve involved is the median nerve in the region of the palm.

If you refer to the diagram (below) you will see that the nerve passes beneath a very strong ligament known as the transverse carpal ligament. This ligament forms the roof of a canal known as the carpal tunnel. There are ten structures that run through this canal: nine tendons (two to each finger and one to the thumb) and the median nerve. For various reasons this canal can become tight and place pressure on the nerve.

The median nerve at this level provides sensation (feeling) to the thumb, index, long and one half of the ring finger. It also provides motor function (power) to the wad of muscles at the base of the thumb.

What Are The Symptoms of Carpal Tunnel Syndrome?

The symptoms are fairly easily understood by understanding the function of the nerve at this level.

The patient will usually complain of a feeling of weakness, clumsiness or fatigue of the hand There is often a feeling of weakness of the thumb especially with activities that require pinch such as using a key, opening a pack of sugar or a door.

There is often a feeling of numbness of the thumb and fingers.

One of the most common and distressing symptoms is repetitive nighttime awakening with significant numbness and pain of the fingers and wrist. The patient will have to get up for a minute, shake out the hand, the symptoms will usually subside and he will be able to go back to sleep.

Occasionally the symptoms are confusing because the pain will present in the elbow or even shoulder when the real problem is in the hand.

What is the Cause of Carpal Tunnel Syndrome?

The actual cause of carpal tunnel syndrome in the majority of patients is unknown. For some reason the canal becomes tight and places pressure on the nerve.

It usually occurs in middle age and women seem to outnumber men 2 to 1. However, it is not uncommon to see it in the young and old, male and female alike.

It is also very common to see people with symptoms of both hands. They will either present with simultaneous symptoms one side usually worse than the other or the opposite side will become symptomatic a few months or years after.

Some causes of carpal tunnel syndrome include trauma to the hand or wrist such as fractures, diabetes, thyroid imbalance, hormone imbalance during pregnancy or menopause or repetitive hand activities like computer use, assembly lines etc.

How Is Carpal Tunnel Syndrome Diagnosed?

The diagnosis of carpal tunnel syndrome is for the most part based on the history and physical exam. There are tests, the electromyogram (EMG) and nerve conduction studies which can help considerably. This measures the function of a nerve in a specific location and usually can determine if there is an abnormality.


What is The Treatment of Carpal Tunnel Syndrome?

• The only successful treatment of significant symptoms is surgery

• Minor symptoms can be treated with anti-inflammatory medications and nighttime splinting of the hand. In most people this seems to be a progressive disorder and what starts out as minor usually progresses to the point where surgery is indicated. If treatment is put off too long ,the symptoms are severe and nerve damage is more than average the symptoms are much slower to resolve even with successful surgery.

• Carpal tunnel syndrome occurring during pregnancy almost always resolves with delivery.

• A night splint can be very useful in helping to relieve the distressing nighttime symptoms if you are not ready for surgery.

• The surgery consists of a short incision in the palm and dividing the transverse carpal ligament to allow more “breathing room” for the nerve.

• Most patients notice a very substantial improvement almost immediately. Minor symptoms continue to improve over weeks and months.