Carpal Tunnel Syndrome is a group of signs and symptoms that is brought on by compression of the median nerve as it passes through the tunnel formed by the carpal bones and the transverse carpal ligament at the wrists. The median nerve along with tendons that flex the fingers pass through this tunnel.
If you have altered sensation, burning, pins and needles tingling or pain, in the thumb, index middle and half of the 4th finger you may have CTS. Electric shock like pain to fingers or pain that goes back up your arm may also be CTS. Some people in advanced cases may develop weakness in the hand, dropping things or not be able to use their fingers properly. These symptoms can take a long time to develop, waking you from sleep, progress to becoming more constant, when doing things with the hands.
There are a variety of things that can lead to the development of compression of the median nerve. Usually it is a combination of things rather than one single thing. These include:
• Age and Gender: being older and female makes you more likely to develop this condition
• Heredity: the size of the carpal tunnel and thus the space available for the median nerve may be genetically related.
• Repetitive hand use: by completing very frequent wrist extension/flexion motions may cause inflammation of the tendons, decreasing the amount of space available and compress the median nerve
• Hand and wrist position: holding the wrist in extension of flexion for extended periods will compress the nerve.
• Pregnancy: hormones can cause swelling of tissues of the body compressing thr median nerve in the tunnel
• Other health conditions such as: Diabetes, rheumatoid arthritis, and thyroid gland imbalance.
Your doctor should clarify what symptoms you have, the severity and length of time of those symptoms, the impact it is having on your day to day life and check your general health to identify possible causes such as diabetes or pregnancy.
There are several clinical examinations they should undertake, they should inspect your hands for wasting of the hand and thumb muscles, test for grip and finger strength, sensation of the fingers and range of motion of the fingers and wrist. Phalen’s and Tinel’s signs should be elicited. Tinel’s is done by tapping over the median nerve to bring on altered sensation in the thumb to 4th finger. Phalen’s sign found when the back of both hands is forced against each other in flexion. A positive sign is when altered sensation in the thumb to 4th fingers is experienced.
Investigations may include nerve conduction studies, to identify if and where the nerve compression is, Ultrasound of the carpal tunnel to measure the thickness of the nerve and rarely MRI in complex cases.
The definitive cure is surgery. This can be done as an open procedure or via endoscopy, with the endoscopic procure having a slight less recovery time. It takes about 6 weeks to recovery fully from the surgery.
It is important that other causes of CTS are corrected prior surgery being undertaken, the diabetes is well controlled, thyroid function controlled and ergonomics corrected as far as practicably possible. Sometimes this reduces the symptoms to the point surgery is not required.
Other interventions such as steroid injections, nerve gliding exercises or wrist braces can assist with symptoms while waiting for surgery.