Carpal tunnel syndrome (CTS) is a common cause for pain, numbness and tingling in the hand, caused by compression of the median nerve as it travels through the wrist(1, 2, 3.) Approximately 15 of every 100,000 individuals will experience CTS per year, with women being at least twice as likely to be affected as men(1).
Pain, numbness and tingling usually occur on the palm and palmar side of the first three fingers from the thumb; weakness can occur in the thumb and adjacent fingers(1, 2). These symptoms are dependent upon the position of the wrist, but usually occur at night and may radiate up the arm as far as the shoulder. Other symptoms can include decreased dexterity, a weak grip, atrophy of muscles in the hand, and feelings of hand swelling(1, 3).
Common causes and predisposing factors for CTS include (1, 2):
- Repetitive strain and prolonged flexion/extension of the wrist, notably from activities such as driving, reading, typing, and holding a telephone
- Rheumatoid arthritis
- Wrist fracture and associated swelling
- Pregnancy/oral contraceptive use leading to swelling in the limbs
- Underlying nerve dysfunctions
Diagnosis and Treatment
Diagnosis of CTS is performed by a doctor and is based on the above symptoms1. A physician may perform a variety of physical maneuvers and/or nerve conduction studies to confirm the diagnosis2, 3.
The goals of treatment are to reduce pain, numbness and tingling and prevent loss of motor function/disability1, 3. Treatment options are plentiful, but depend upon the severity of CTS and patient preference2. Most mild to moderate cases of CTS can be effectively managed with a combination of conservative treatments which include1, 2, 3:
- Minimizing contributory factors such as repetitive use/strain
- Wrist splinting helps keep the wrist in a neutral position, limiting prolonged extension/flexion
- Glucocorticoids (steroids) can be taken orally or injected into the carpal tunnel to reduce inflammation and compression
- Deep, pulsed ultrasound can be used to decrease pain and promote soft tissue healing
Yoga has been shown to be effective for pain control
For symptoms that do not improve with conservative treatment within 6 months, the definitive treatment for moderate or severe CTS is surgical decompression of the median nerve. Surgical intervention is generally more effective than conservative treatments with improvement in approximately 85-90% of cases1, 2. Surgery can be performed via open incision or endoscopically1, 3:
- An open release is performed via standard incision under local anesthesia, and allows a surgeon the best view
- An endoscopic release is performed with scopes and surgical tools through one or two small openings, and can result in less scar tissue and post-operative pain
The prognosis for CTS is good, although a minority of patients, particularly those with advanced CTS, may fail to improve after surgery(1). Additionally, scarring post-surgery can lead to a recurrence of symptoms several months or years later. The best way to treat CTS is to prevent it altogether by minimizing the aggravating and repetitive tasks previously discussed and keeping wrists in a neutral position as often as possible(1).
- Scherger, J.E.; et al. (2007). Carpal tunnel syndrome. First Consult. MD Consult Web site, Core Collection. Retrieved from http://www.mdconsult.com.ezproxy2.library.arizona.edu/das/pdxmd/body/269737155-3/0?type=med&eid=9-u1.0-_1_mt_1014449.
- Scott, K.R.; Kothari, M.J. (2011). Treatment of carpal tunnel syndrome. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- Hunter, A.A.; Simmons, B.P. (2010). Surgery for carpal tunnel syndrome. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.