Orthopedic Care Specialists

Carpal Tunnel Syndrome: Symptoms & Treatment

Anatomy of Carpal Tunnel

Carpal Tunnel syndrome (CTS) is a common problem affecting the wrist and hand. Symptoms begin when the median nerve gets squeezed inside the carpal tunnel of the wrist.

The carpal tunnel is an opening through the wrist to the hand, a canal formed by the bones of the wrist on one side and the transverse carpal ligament of the other. Ligaments are structures that connect bones together. Within the tunnel are the flexor tendons, which allow movement of the fingers, thumb, and hand. The median nerve runs on top of the tendons, passes through this tunnel into the hand. The nerve provides sensation to the thumb, index finger, long (middle) finger, and half of the ring finger. It also controls the muscles that move the thumb and let you touch the pad of thumb to the tips of each finger.

Causes of Carpal Tunnel Syndrome

Any condition that makes the area inside the tunnel smaller or causes inflammation (swelling) of the tissues in the tunnel can cause symptoms of carpal tunnel syndrome (CTS). Some causes include:

• Repetitive motions of the wrist / hand
• Broken or dislocated bones in the wrist which produce swelling
• Arthritis, especially the rheumatoid type
• Medical conditions including diabetes and thyroid gland imbalance

Also the way people do tasks can put them at risk for problems. Some risks include force, posture, wrist alignment, repetition, and vibration. The longer a person is exposed to these risks the greater the possibility of having a problem.

Carpal Tunnel Syndrome Symptoms

Symptoms of carpal tunnel syndrome include:

• Numbness and tingling in the hands
• Decreased sensation in the thumb, and fingers
• Pain when holding the wrist in a bent position for a period of time (the hand may begin to feel like it's asleep)
• Muscle weakness - difficulty with grasping objects

Carpal Tunnel Syndrome Treatment

Diagnosing CTS

Your doctor will begin with an evaluation including your description of the symptoms as well as physical examination. The physician may also have you undergo an electrical study of the nerves. The tests determine how fast the nerve impulses move through the nerve.

Non-Surgical Treatment

• Anti-inflammatory medications: over the counter medications may also help control the swelling and reduce the symptoms.
• Bracing: A wrist brace will sometimes decrease the symptoms during the early stages. A brace keeps the wrist in a resting position (not bent up/down). With the wrist in this position the carpal tunnel is as big as it can be so the nerve has room in the tunnel. The brace can be helpful at easing the symptoms at night because it can keep your hands from curling in your sleep; during the day it can help rest the tissues in the tunnel.
• Physical / Occupational Therapy: the goal of therapy is to reduce or eliminate the cause of pressure in the carpal tunnel.
• Activity Modification: Changing patterns of hand use to avoid activities that aggrate the condition. Avoiding repetitive hand motions, heavy grasping, holding onto vibrating tools, and working with your wrist bent down.
• Corticosteroid Injection: Used to reduce the swelling in the tunnel and may give temporary relief of symptoms.

Surgical Intervention for Carpal Tunnel Syndrome

If all forms of non-operative treatment fail and the pain continues to limit ability to perform daily activities, surgery may be considered to reduce the pressure on the median nerve. The decision to have surgery is based on the severity of the symptoms.

During surgery, a cut (incision) is made in the palm or wrist. The roof of the carpal tunnel is incised. This increases the size of the tunnel and decreases pressure on the nerve. Most patients see their symptoms improve after surgery, but recovery may be gradual. On average, grip and pinch strength generally return by about 2 months after surgery. Complete recovery may take up to a year. If carpal tunnel syndrome has been present longer and the nerve is more severely affected before treatment is attempted, recovery is slower and in some cases symptoms are not entirely alleviated.