Carpal Tunnel Syndrome 101

Carpal Tunnel Syndrome 101 - MalaysiaAcute Conditions

Carpal Tunnel Syndrome 101: Symptoms, Causes & Treatment

Carpal tunnel syndrome is caused by the compression of the median nerve and causes tingling, pain and numbness in the hand and arm. Learn more about its causes, symptoms and available treatment options.

What is Carpal Tunnel Syndrome (CTS)?

Carpal tunnel syndrome occurs when the median nerve, located from your forearm into the palm of the hand, is compressed, leading to numbness, tingling and weakness in your hand (except the little finger). It is sometimes referred to as median nerve entrapment or median nerve compression.

The condition refers to the carpal tunnel, a passageway located in the wrist. It contains the median nerve and tendons that connect the hand and the forearm, as well as ligaments and bones that surround the carpal tunnel and keep it in place. The tendons are responsible for bending the fingers and thumb, while the median nerve provides sensation to most of the fingers (except the little finger) and thumb. A common myth about CTS is that it only happens to those who regularly use a computer. CTS can happen to anyone above age 20, especially those who use their hands and wrists repeatedly for various activities. The risk of developing CTS increases as one ages.

Symptoms of Carpal Tunnel Syndrome (CTS)

CTS symptoms may often appear gradually. Among the symptoms you may experience can include (but are not limited to):

  • Numbness and/or tingling in the fingers and hand (which may worsen at night or when waking up)
  • Feeling pins and needles in the fingers and hand
  • Difficulty feeling with the fingertips
  • Reduced sensitivity to external stimuli (i.e. heat)
  • Gradual difficulty doing tasks with the affected hand
  • Growing weakness in the hand
  • Reduced hand dexterity
  • Swelling on the fingers

In some cases, there may be discomfort that can occur anytime, even at night. You may feel inclined to “shake out” your hand to relieve the numbness or discomfort you are feeling. The sensations may not necessarily occur in the hands and fingers, but even along the wrist. In more severe cases, the muscles might even atrophy and weaken, even more, causing you to drop things more frequently than usual.

If you experience these symptoms constantly and with no relief, see a medical professional immediately.

What Causes Carpal Tunnel Syndrome (CTS)?

Pressure on the carpal tunnel can be affected by certain positions of the wrist. If the pressure builds up within the carpal tunnel, it can end up pinching, or hurting, the median nerve and cause it to function poorly. Doing certain things, such as holding a tight closed fist or putting your wrist in a bent or extended positions, can also put increased pressure on the median nerve.

Repetitive activities that involve constant hand and wrist movement, or using vibrating tools, could also potentially cause a build-up of pressure on the median nerve. In fact, repetitive motions could even cause swelling of the membranes that surround the tendons in the carpal tunnel, leading to mild discomfort or even pain. These activities may include handling vibratory tools such as drills, regular painting, or improper hand positioning when using computers.

Symptoms may occur infrequently, but as time progresses, and pressure continues to be applied to the nerve, symptoms may very well be a constant experience until it is treated. Some other causes can arise from poor postures when doing activities, and consistent practices that put increasing pressure on the nerve and tendons.

However, how CTS manifests may vary greatly from person to person. The exact cause is not very well understood, so despite repetitive activities and vibration being able to cause symptoms to arise, it may instead be likely that these activities are only aggravating symptoms that have been there for much longer.

Risk Factors of Carpal Tunnel Syndrome (CTS)

There are a number of risk factors that could contribute to CTS.

  • Wrist injury (fracture, dislocation, etc.)
  • Rheumatoid arthritis (stiffness and/or inflammation of the joints)
  • Anatomic issues (e.g. small carpal tunnel, deformities)
  • Diabetes
  • Obesity
  • Nerve damage
  • Gender (women are at higher risk of developing CTS)
  • Age (between the ages of 40 to 60)
  • Repetitive use of the hand and wrist for activities
  • Exposure to vibration

Note that having a risk factor does not mean that you will develop CTS.

Diagnosing Carpal Tunnel Syndrome (CTS)

If you notice that you or your loved one have been experiencing CTS symptoms for some time, it is best to seek medical treatment immediately, before the symptoms worsen. The doctor will assess medical history first, to ascertain there may not be risk factors present that could confirm that it is CTS. They may ask you a variety of questions to assess your condition.

A physical examination will also be done to note the symptoms present. The attending doctor will check for you or your loved one’s ability to perform (or not perform) certain actions, such as range-of-motion exercises, allowing them to narrow down the cause of your discomfort or pain. They may also perform a compression test to force the symptoms to appear. One such test is Tinel’s sign, where the doctor taps over the wrist in order to produce a tingling in the fingers.

Other diagnostic tests may be done in order to determine if you or your loved one may have CTS.

  • Imaging scan: An MRI or ultrasound scan may help to identify the problem by creating an image of your carpal tunnel. This can help in determining if its really is CTS.
  • Electromyography (EMG): This test checks for tiny electrical discharges produced by the muscles. A thin-needle electrode will be placed into specific muscles to check the electrical activity when muscles contract and rest. This tests for whether the muscles are correctly responding to nerve signals it receives.
  • Nerve conduction studies: Somewhat similar to an EMG, this tests for the speed at which an electrical pulse travels along the median nerve. Two electrodes are taped to the skin, and a small electrical shock is passed through the median nerve. This test looks for disruptions or damage to the nerve.

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Treatment of Carpal Tunnel Syndrome (CTS)

The treatment of CTS depends on whether it is severe or otherwise. For less than severe cases of CTS, non-invasive treatment is recommended.

Non-surgical Treatment Options

This generally involves wearing a wrist splint at night before you or your loved one goes to sleep. A splint basically holds your wrist in a fixed position, which helps to reduce or stop pressure on the median nerve. While it is only worn at night, it can help with improving daytime symptoms. For pregnant women with non-severe CTS, this is the best option for treatment without needing to prescribe medications that could interfere with their pregnancy. Make sure the splint aligns the wrist in a comfortable, neutral position for best results.

You or your loved one may also be prescribed nonsteroidal anti-inflammatory drugs, or NSAIDs, as a short-term pain relief provider in the case of inflammation that causes CTS. However, there is little evidence to show the efficacy of these medications in treating CTS in the long term; they are best used for mild CTS cases. If anything, they only reduce the severity of symptoms. Consult your doctor on the use of NSAIDs before taking any.

A corticosteroid injection may also be a consideration to treat CTS. This involves injecting the carpal tunnel, sometimes guided by ultrasound, with a corticosteroid to relieve pain. The jab helps to reduce inflammation and swelling, which helps to take pressure off the median nerve and allow it to recover. You or your loved one may also be offered an oral corticosteroid instead of an injection, depending on the situation, but injections are generally considered to give better results.

Some physical therapy can also help to treat CTS, so long as the prescribed exercises do not put too much strain on the hand and/or wrist. The therapist may teach nerve and tendon gliding exercises, and hand motions that keep the nerves and tendons sliding smoothly through the carpal tunnel. In tandem with this, you or your loved one may also need to make changes to your working or home environment to reduce the chances of CTS recurring.

Surgical Treatment Options

If non-surgical treatment and rehabilitation options have no effect in improving CTS symptoms, surgery may ultimately be needed to treat it effectively. Specifically, the method commonly used is known as carpal tunnel release.

The ultimate goal of surgery is to relieve pressure on the median nerve by “releasing” (hence the name) the carpal tunnel ligament that covers it at the base of the palm. This is achieved by making an incision in the ligament that presses on the median nerve. There are two effective options for surgery: the endoscopic method, and open surgery.

Endoscopic surgery involves the use of an endoscope, a small telescope-like device mounted with a camera. The surgeon will make one or two small incisions in the wrist and palm, and the endoscope will be inserted to examine the carpal tunnel. A small knife is then inserted through the endoscope to cut the ligament.

Open surgery, on the other hand, requires making a surgical incision in the palm of the hand, or the wrist, over the carpal tunnel. From there, the ligament that presses on the median nerve will be cut. The procedure will be done under local anaesthesia.

Once the surgery is complete, you or your loved one’s wrist will be placed in a splint for a week or two, depending on your recovery. There will be some pain, so painkillers will be prescribed to mitigate the pain. Recovery will still take some time, so be sure to minimise activities that require the use of the recovering hand and return for regular follow-up checks to assess the recovery process.

Endoscopic surgery has the best outcome of the two options. While there is some risk of nerve damage during the endoscopic procedure, it does have the highest rate of recovery among the two. It may also result in much less pain post-surgery compared to open surgery. Nevertheless, it is always a good idea to discuss with the doctor what the risks of surgery are.

Post-Surgery for Carpal Tunnel Syndrome (CTS)

After surgery, your wrist may be placed in a sling to help it recover. There may still be some lingering pain from the surgery, so you may be prescribed painkillers to help. Avoid doing even simple tasks with your arm so as to not interrupt with its recovery. A physiotherapist may recommend some exercises for your hand and wrist, to help hasten recovery. Get sufficient rest once you are discharged as well. Under positive circumstances, the recovery period may be quick, and some cases even immediate.

If the pain has not subsided, or if recovery is taking very long, do not delay and see the doctor immediately for further advice.

Preventing Carpal Tunnel Syndrome (CTS)

CTS can develop when too much pressure is placed on the wrist. Minimising pressure is the best way to prevent CTS from occurring, and requires some concerted effort to do daily activities differently. Here are some tips that may help:

  • Relax your grip when handling objects with your hands and wrist
  • If working at the computer, reduce the force applied to keys
  • Take 10 to 15 minutes breaks every hour
  • Stretch the hand and wrist, but do not overdo it
  • Keep wrists straight, or at a neutral position
  • Switch hands when doing tasks
  • Maintain a good posture when standing or sitting
  • Use a splint at night before sleeping

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