What is Carpal Tunnel Syndrome or CTS?
Carpal Tunnel Syndrome (CTS) is the most frequent and well known median nerve compression. Carpal tunnel is an anatomical compartment (canal) bounded by bones of the wrist and transverse ligament (thick fibrous bend). The median nerve passes through this canal along with few other tendons and goes to fingers. Any conditions, that causes an increase in pressure in this tunnel, can push/squeeze/impinge the nerve inside this tunnel. This, in turn, brings symptoms like numbness, tingling, inability to hold or grasp an object etc.. This is called carpal tunnel syndrome or CTS.
In a healthy individual, a pressure in carpal tunnel is low (around 2 to 31 mm of Hg) while in patients with CTS, this pressure is found to be somewhere between 32 to 110 mm of Hg. Wrist and finger movements like bending and stretching also increase the pressure. The constant increase in pressure causes median nerve to swell and get squashed inside the tunnel. Carpal Tunnel is usually a progressive disease with gradual onset. Below are the main physical symptoms that you will find with CTS.
What are the typical signs of Carpal Tunnel Syndrome?
- Initially, burning, tingling, itching or numbness in the palm of the hand, thumb, index and middle fingers, and on the inner side of the ring finger
- Night time pain is common at an early stage. Day and night pain becomes evident as the disease progresses.
- Weakness on hand and wrist
- Clumsiness on hand and wrist
- Pins and needles sensation
- Poor hand grip
- You will see your patient “shaking out” the hand to relieve the symptoms.
- In severe or prolonged cases, a permanent nerve damage can happen. This can cause atrophy of thenar (thumb) muscles.
What causes CTS?
Anything that causes an increase in pressure in the tunnel can cause CTS symptoms. This impinges the nerve or causes swelling of the median nerve. Females are more common to have CTS than males.
Below are few causes of CTS.
- Congenital predisposition
- Work-related injuries
- Arthritis or fractures
- Pregnancy
- Diabetes
- Benign Tumors
How do you prevent Carpal Tunnel Syndrome?
- Activity modification
- Regular wrist exercises and stretching
- wrist stretching
- wrist bending
- fingers and thumb bending
- Taking frequent breaks
- Wrist Braces
Treatment Choices for CTS:
The purpose of treatment is to alleviate the symptoms and, in some people, prevent worsening of the condition.
Drug Therapy:
- Non-Steroidal anti-inflammatory drugs (NSAID)
- Lidoderm Patches
- Diuretics
- Vitamin B6: Supplementation of Vitamin B – 6 is proven to help with CTS symptoms in research.
The recommendations of the American Academy of Neurology for treatment suggests splinting, activity modification, and non-steroidal anti-inflammatory drugs—and possibly diuretics if there is limb swelling—as conservative treatment, followed by steroid injection and surgery.
Stretches and Exercises for CTS:
See my post on Stretches and Exercises for Carpal Tunnel Syndrome (CTS).
Braces/Wrist support :
Wrist braces are helpful to support the area. The research, in this case, is inconclusive. I have had many of my friends try the wrist support who has pain due to CTS. The good thing is there are no side effects to this. Resting hand splints are better to avoid any further injury to your wrist. It can be a subjective decision of a person, to use the brace or not.
Surgical Interventions:
Surgical measures are considered when all other conservative treatments fail and patients still show clinical symptoms. The goal of surgery is to reduce pressure on the median nerve and allow the nerve and tendons to glide smoothly.
The surgical treatments include:
- Standard open carpal tunnel release (OCTR).
- Endoscopic carpal tunnel release (ECTR)
- Open carpal tunnel release with additional procedures such as internal neurolysis, epineurotomy or tenosynovectomy.
- Open carpal tunnel release using various incision techniques.
Other treatment strategies:
Below are few other treatment approaches that a healthcare professional may choose.
- Chiropractic manipulation of the wrist
- Ultrasonography
- Acupuncture
- Magnet Therapy
- Cognitive behavior therapy
Some questions that still need to be answered in research are:
- Universally established treatment choice for every case
- Does overuse of the hand in certain occupations cause CTS?
- What factors predict response to treatment?
References:
- Ibrahim I, Khan W S, Goddard N, Smitham P. Carpal Tunnel Syndrome: A Review of the Recent Literature. Orthop J. 2012; 6: 69-76
- Bland J.D. Carpal Tunnel Syndrome. BMJ. 2007; 335(7615): 343–346
- Carpal Tunnel syndrome: physical therapy or surgery? 2017; 47 (3): 162
- Janine S., Denise R. Carpal Tunnel Syndrome: symptoms, diagnosis, and treatment options. Journal of the American Academy of Physician Assistants. 2012; 25 (9), 22-26.
- Shi Q, MacDermid J. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. Journal of Orthopaedic Surgery and Research. 2011; 6:17.