CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome (CTS) is a condition where patients experience pain and “pins and needles” in the hand. There is a tunnel on the palm side of the wrist where the median nerve and all the finger tendons pass into the hand.  The nerve is a soft delicate structure and any rise in pressure within the tunnel cuts off circulation inside the nerve and it begins to hurt.

CAUSES

There can be many causes of this condition but in most cases the true cause is unknown.  In some cases, there is an identifiable cause for the increased tunnel pressure such as:

•  Swelling of the lining of the flexor tendons, called tenosynovitis
•  Joint dislocations
• Fractures
• Arthritis
• Fluid build-up during pregnancy
•  Hormonal disturbances such as hypothyroidism and changes with menopause

SIGNS AND SYMPTOMS

The symptoms are typically episodic in early stages often worse with excessive hand use and felt most at night. Activities that require prolonged grip such as holding a phone, reading a newspaper, driving can also provoke symptoms.  The symptoms include:

• Pain
•  Numbness
•  Tingling
•  Weak grip
•  Occasional clumsiness
•  Tendency to drop things

Since the little finger is supplied by the ulnar nerve that lies outside the carpal tunnel, it is often spared the symptoms of CTS. In bad cases, sensation and strength may be permanently lost.

HOW TO DIAGNOSE CTS

Your doctor can usually make the diagnosis of CTS by a detailed history and examination of the hand in the clinic. Nerve conduction studies are usually done to confirm the diagnosis prior to surgery.

X-rays and other tests are not usually necessary. Blood tests may be done if hormonal imbalance or other disorders such as diabetes or rheumatoid arthritis are suspected.

TREATMENT

In early cases with mild symptoms, splinting and anti-inflammatory medications may alleviate symptoms.  A brace to support the wrist at night is particularly useful for patients who wake up from sleep with symptoms. It may also be useful to consider other changing the way hands are used where possible. A steroid injection into the carpal tunnel is quite helpful in alleviating symptoms in mild cases.

Surgery is performed when symptoms are severe or do not improve.  Pressure on the nerve is relieved by cutting the ligament that forms the tunnel roof through a small incision in the base of the palm. Surgery is performed under local anesthesia and does not require overnight admission to hospital. The symptoms usually resolve rapidly after surgery but some soreness in the incision can last up to 12 weeks. Numbness and weakness may only resolve partially especially in severe cases.