Carpal tunnel syndrome (CTS)
Carpal tunnel syndrome is associated with pain, weakness and numbness in the hand, especially on the inner side of the thumb, index and middle finger, caused by pressure on the median nerve in the wrist. Although the condition is often the result of more than one factor, there are some conditions that trigger CTS, e.g. anything that irritates or compresses the median nerve in the carpal tunnel space. The affected person has to see a doctor when the symptoms worsen. If left untreated, carpal tunnel syndrome may lead to permanent nerve and muscle damage.
The condition normally starts gradually with numbness or tingling in thumb, index and middle finger. It appears and disappears.
Signs might include:
- Tingling or numbness in fingers or hand, particularly in thumb, index, middle or ring fingers (e.g. when the affected person wakes up from sleeping, holds a phone, newspaper, steering wheel) – sensation may extend from the wrist up the arm
- Weakness in the hand (people with the condition tend to drop things)
The median nerve runs from the forearm through the carpal tunnel (passageway in the wrist) to the hand. If the median nerve is compressed, the syndrome occurs. It’s accompanied by sensation to the palm side of the thumb and fingers (except little finger) and nerve signals to move the muscles around the base of the thumb.
Although the condition is often the result of more than one factor, there are quite a few conditions that trigger CTS, e.g. anything that irritates or compresses the median nerve in the carpal tunnel space, such as a wrist fracture, swelling from pregnancy, rheumatoid arthritis, diabetes, hypothyroidism or certain patterns of hand and arm use, e.g. heavy manual work, work with vibrating tools or highly repetitive tasks (writing on the computer keyboard, etc.).
If the symptoms interfere with everyday life as well as sleep and if they don’t go away anymore, a doctor’s visit is needed. Without treatment, the condition can lead to permanent nerve and muscle damage.
CTS should be treated as early as possible. In milder cases, the affected people can ease the symptoms by taking frequent breaks to rest their hands, and by applying cold packs to reduce the swelling.
If these measures don’t help within a few weeks, additional treatment options may include:
- Wrist splinting at night to reduce tingling and numbness, e.g. if the patient is pregnant
- Nonsteroidal anti-inflammatory drugs (e.g. Ibuprofen) for fast pain relief
- Corticosteroids in order to decrease inflammation and swelling
- If CTS is caused by an inflammatory arthritis, e.g. rheumatoid arthritis, then treating the arthritis might reduce signs of carpal tunnel syndrome.
In severe cases, surgery may be the right option. The goal is to relieve pressure on the median nerve by cutting the ligament pressing on it.
There are two different techniques:
- Endoscopic surgery: The surgeon cuts the ligament through one or two small incisions in hand or wrist. In comparison to open surgery, this method may cause less pain in the first days after surgery.
- Open surgery: After a larger incision (or sometimes a smaller one) in the palm of the hand over the carpal tunnel, the surgeon cuts through the ligament to free the nerve. If the incision is smaller, the risk of complications decreases.
During the healing process, the ligament tissues gradually grow back together, and the nerve now has more room than before. The patient should use his/her hand gradually in a normal way but avoid forceful hand motions or extreme wrist positions. Sometimes it may take some months before the symptoms go away.
Although carpal tunnel syndrome cannot be prevented, it’s possible to minimize stress on the hands and wrists by:
- Giving hands and wrists a break by stretching and bending them periodically
- Keeping the computer keyboard at elbow height or a bit lower
- Relaxing the grip (e.g. of a pen while writing)
- Avoiding incorrect posture which might have a negative impact on fingers, wrists and hands due to compressed nerves in the neck
- Avoiding cold hands (fingerless gloves help in cold working environments)