CARPAL TUNNEL SYNDROME
CARPAL TUNNEL SYNDROME (CTS)
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is a common condition caused by compression of the median nerve as it passes through a tunnel as it crosses into the hand.
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What are the causes?
The median nerve is trapped in front of the wrist. Normally the nerve and the tendons bending the fingers pass through a tunnel across the front of the wrist. The roof of the tunnel is made of a tight and thick fibrous ligament. Pressure on the nerve can happen several ways: swelling of the lining of the flexor tendons, called tenosynovitis; joint dislocations, fractures, and arthritis.
- Fluid retention during pregnancy can cause swelling in the tunnel and symptoms of carpal tunnel syndrome, which often goes away after delivery.
- Thyroid conditions
- Rheumatoid arthritis, and diabetes also can be associated with carpal tunnel syndrome.
Symptoms
Typically, patients present with pins and needles in the hand usually affecting the thumb, index and middle fingers. These are usually worse at night, driving, holding book for long period of time.
The symptoms are often relieved by shaking of the hand. Permanent numbness and wasting of muscle are present in later stages of the condition.
What happens if nothing is done?
If nothing is done to the affected hand, some people’s symptoms resolve especially if they come on associated with pregnancy. Most people develop gradually increasing symptoms over months to years. Most people are particularly troubled by night waking, often in the early hours of the morning. If left for too long permanent numbness, muscle weakness and wasting can occur. This reduces hand function considerably.
Diagnosis
- In Carpal Tunnel Syndrome (CTS) the diagnosis is usually done by undertaking a detailed history and examination of the hand including the whole upper limb including the neck may be required to rule out other causes of tingling.
- Nerve Conduction Studies (NCS / EMG): These tests can determine how well the nerve is working and help identify where it is being compressed. Nerves are like “electrical cables” that travel through your body carrying messages between your brain and muscles. When a nerve is not working well, it takes too long for it to conduct. Nerve conduction studies can also determine whether the compression is also causing muscle damage. Muscle involvement is a sign of more severe nerve compression.
- MRI of the neck may be requested to rule out a spine problem mimicking CTS.
Non-operative Treatment
- These include activity modification, splints and non-steroidal anti-inflammatory medications. The splint is mainly worn at night to prevent waking.
- An injection of steroid and local anaesthetic can relieve the symptoms, in most people, at least in the short-term.
- In cases where the clinical picture is unclear a positive response to an injection helps confirm the diagnosis.
Surgical Treatment
This involves releasing the carpal tunnel which is mostly done under local anaesthesia as a day case procedure.
Read more about Carpel Tunnel Release.