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Article written by Cosimo Simeone, Msc, PgdDip, Bsc, Physiotherapist

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is a condition that affects the hand and wrist, resulting from compression or pressure on the median nerve. It passes through the carpal tunnel, a narrow formed by the wrist’s bones and ligaments. To understand CTS better, let’s delve into the anatomy of the median nerve and its innervation in various parts of the body.

The median nerve is one of the major nerves in the upper extremities. It origins from the brachial plexus, a network of nerves that arise from the cervical spinal roots. It primarily receives contributions from the C5 to T1 spinal nerve roots. These nerve roots combine to form the median nerve. Furthermore, it travels down the arm, passing through the axilla and the front of the elbow.

As it continues its journey, the median nerve innervates muscles in the forearm. It allows specific movements such as bending of the wrist and fingers. Additionally, it provides sensation to the skin on the palm side of the thumb, index, middle, and ring fingers, including the fingertips.

Upon reaching the wrist, the median nerve enters the carpal tunnel. This is a narrow and rigid passageway formed by the carpal bones on the bottom and sides, and a tough ligament on top. The carpal tunnel houses not only the median nerve. But also several tendons responsible for finger movement. In CTS, the carpal tunnel becomes narrowed or inflamed, leading to compression of the median nerve.

Causes of the carpal tunnel: 

Several factors can contribute to the development of CTS. The exact cause of carpal tunnel syndrome is not always clear (1). Some of the common causes and risk factors include:

  • Anatomy of the Wrist: Individuals with a naturally smaller carpal tunnel may be more susceptible to median nerve compression.
  • Repetitive Hand Use: example typing on a keyboard, using a mouse, or performing assembly line work, can increase the risk of developing CTS.
  • Wrist Positioning: Prolonged or repetitive wrist flexion or extension can put additional pressure on the median nerve, leading to its compression.
  • Medical Conditions: Rheumatoid arthritis, diabetes, and thyroid disorders, are associated with an increased risk of carpal tunnel syndrome.
  • Wrist Injuries: Fractures, sprains, or other injuries to the wrist can lead to swelling and inflammation. These can put more pressure on the median nerve.
  • Hormonal Changes: Hormonal changes during pregnancy can cause fluid retention and swelling. These may contribute to carpal tunnel syndrome.
  • Genetics: Some individuals may be more prone to developing it due to genetic predisposition.
  • Age and Gender: CTS is more common in individuals over the age of 50. In addition, women are more likely to be affected than men.
  • Obesity: Being overweight or obese can increase the risk of developing carpal tunnel syndrome.

Symptoms and signs of CTS:

These are the common symptoms and signs of carpal tunnel syndrome:

  • Numbness and Tingling: The most common symptom of CTS is numbness and tingling in the thumb, index finger, middle finger, and half of the ring finger. This sensation often occurs during activities that involve bending the wrist, such as typing or holding a phone.
  • Hand Weakness: People with CTS may experience weakness in their hand, making it challenging to grip objects or perform tasks that require fine motor skills.
  • Pain and Discomfort: Patients may feel pain in the hand or wrist that can radiate up the forearm. The pain might be dull or sharp and can be more intense during the night.
  • Burning Sensation: Some individuals with CTS report a burning sensation in their hand or fingers.
  • Nighttime Waking: CTS symptoms often worsen at night, leading to interrupted sleep or waking up with a need to shake out the hand for relief.
  • Difficulty with Fine Movements: Carpal tunnel syndrome can interfere with activities that involve intricate hand movements, such as buttoning shirts or writing.
  • Hand Clumsiness: Individuals may experience a decreased ability to coordinate movements of the hand, leading to a sense of clumsiness.
  • Thumb Muscle Wasting:  In chronic or severe cases of CTS, the muscles at the base of the thumb may start to shrink or waste away.

Diagnosis of CTS: 

Diagnosing CTS involves a comprehensive evaluation of a person’s symptoms, medical history, and physical examination. The process is aimed at understanding the individual’s complaints and ruling out other potential causes of their symptoms.

When someone presents with symptoms of CTS, the first step is to take a detailed medical history. Moreover, the healthcare professional will inquire about the nature of the symptoms and their duration. Also any potential factors that might worsen or alleviate them.

Next, the doctor will perform a physical examination focused on the hands, wrists, and arms. They may gently tap or press on the wrist to check for tenderness and to elicit specific sensations. Additionally, they might evaluate the strength and coordination of the affected hand and fingers.

Furthermore, the healthcare provider during the physical examination may assess for Tinel’s sign and Phalen’s test. Tinel’s sign involves lightly tapping on the median nerve at the wrist to see if it triggers tingling or electric shock-like sensations in the hand. Phalen’s test involves flexing the wrist to its maximum for about a minute to see if it induces symptoms (2).

What else can be done to detect CTS?

To support the diagnosis, nerve conduction studies and electromyography (EMG) might be conducted. Nerve conduction studies measure the speed and strength of electrical signals along the nerves, including the median nerve that runs through the carpal tunnel. EMG records the electrical activity of the muscles. Therefore, will help to determine if there is any muscle damage associated with nerve compression.

Apart from these assessments, imaging tests like ultrasound or MRI might be ordered to rule out other potential causes of the symptoms, such as wrist fractures or tumors. It’s crucial for the healthcare professional to take a holistic approach. Considering the patient’s overall health, daily activities, and any potential occupational factors that might contribute to the development of CTS.

Next once all the data is collected and analyzed, the healthcare provider can make an informed diagnosis. Moreover, If CTS is confirmed, appropriate treatment options can be discussed. These can range from conservative measures like splinting and physical therapy. More invasive treatments include corticosteroid injections or surgical intervention.

Overall, the diagnosis of carpal tunnel syndrome requires a combination of Three things. Firstly attentive history-taking, thorough physical examination, using specific tests to confirm the presence of median nerve compression.

Treatments options for CTS: 

Carpal tunnel syndrome (CTS) can be treated using various approaches, depending on the severity of the condition (3). Here are some common treatments for carpal tunnel syndrome:

  • Wrist Splints: Wrist splints could help to reduce symptoms and pressure on the nerve. The splint should be used in neutral position for a minimum of 20 minutes and up to 3 times a day. Furthermore use the splint during the day and not night or during activities.
  • Corticosteroid Injections: In more severe cases, corticosteroid injections may be administered directly into the carpal tunnel to reduce inflammation and relieve symptoms.
  • Activity Modification: Avoiding repetitive hand and wrist movements or taking regular breaks can help prevent aggravation of CTS symptoms.
  • Hand Exercises: Specific exercises can strengthen the hand and wrist muscles, improving flexibility and reducing pressure on the median nerve.
  • Cold Therapy: Applying cold packs to the affected wrist can help reduce swelling and numbness.
  • Ergonomic Workspace: Ensuring a proper ergonomic setup at work and home can prevent CTS or reduce its impact. You can find some useful ergonomics that would reduce your pain here on our shop.
  • Ultrasound Therapy: Ultrasound can be used to promote blood flow, reduce inflammation, and alleviate pain in the affected area.
  • Hand Therapy: Occupational therapy focused on hand and wrist exercises can be beneficial for managing carpal tunnel syndrome.
  • Lifestyle Changes: Maintaining a healthy lifestyle, including managing weight and addressing underlying health conditions like diabetes, can help manage CTS symptoms.
  • Alternative Therapies: Some people find relief through alternative therapies such as acupuncture or osteopathic care.
  • Surgical Intervention: In severe or persistent cases, carpal tunnel release surgery may be recommended to relieve pressure on the median nerve. This procedure involves cutting the transverse carpal ligament to enlarge the carpal tunnel and reduce pressure on the nerve.

Is it worth getting carpal tunnel surgery?

The worth of getting carpal tunnel surgery depends on three factors. These are the severity of your condition, the impact of symptoms on your daily life, and the effectiveness of other non-surgical treatments. For individuals experiencing mild to moderate carpal tunnel symptoms could be beneficial. These conservative approaches can be effective in managing symptoms and improving hand function. The most important thing is to start treating it as quick as possible without aggravating it.

Surgery may be a viable option if carpal tunnel syndrome progresses and symptoms become more severe. Carpal tunnel release surgery aims to alleviate pressure on the median nerve. How does it works? It cuts the transverse carpal ligament and enlarge the carpal tunnel. Moreover, this procedure can be performed through traditional open surgery or minimally invasive endoscopic techniques.

The benefits of carpal tunnel surgery can be significant for individuals whose symptoms interfere with daily activities, work, and sleep. Also when conservative treatments have not provided adequate relief. By reducing pressure on the median nerve, surgery can relieve the symptoms. Consequently improving hand function and quality of life.

It’s important to note that carpal tunnel surgery, like any surgical procedure, carries some risks, including infection, nerve or blood vessel damage, and scarring. Additionally, there may be a period of post-operative recovery. During it, you may need to limit certain activities to allow the wrist to heal properly.

However you need to be assessed by a specialist such as orthopedic who can check out your condition. If the specialist think that the surgery is indicated, he will also explain you potential risks and benefits. I also recommend to see different specialist to have also another opinion.

Conclusions:

CTS is a common issue that can be treated conservative way or surgically in the worst case scenario. I recommend to have a look on this website page to read another point of view of the CTS from a very important authority.

If you wish to see a physiotherapist I really recommend to book a digital appointment with us here. Our expert physiotherapist can drive you to the best treatment options with exercises therapy focus to reduce pain and improve your activity of daily living.

But also advices in how to manage the pain and change your painful habits. Many people found beneficial our treatments options and we have cured thousands of patients with some symptoms. Hopefully to see you soon and I wish you enjoyed and found helpful this article.

Article Designed by Cosimo Simeone

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