What is it?

Carpal tunnel syndrome (CTS) is when the median nerve becomes entrapped/squeezed at the wrist, thus sensation of pain, weakness or numbness of the hand, wrist and radiating upwards along the arm. 

The median nerve runs along the forearm and into the palm of the hand, this nerve receives signals from the thumb, forefinger, middle finger and half of the ring finger and also from some of the small muscles that allow the fingers and thumb in the hand to move and flex. 

The carpal tunnel is a passageway in the wrist that continues into the hand, it is surrounded by the bones of the wrist from underneath and the transverse ligament from the top. The carpal tunnel houses the nine flexor tendons and the median nerve which is the most superficial of the ten thus is the most likely to be compressed and be the cause of the symptoms and pain. 

Potential causes

The pain associated with CTS is disputed; some experts claim it is the direct pressure on the nerve while others say that it is the pressure that obstructs blood flow to the nerve causing the pain, aggravating factor may be:

  • Oedema– Fluid retention that is common in overweight people as well as women in menopause or pregnant. The wrist is susceptible to oedema because of its normal gravitational position, (pointing downwards) CTS due to oedema is usually affecting both sides and is quite common.
  • Subluxation– The carpal bones can subluxate (partial dislocation) toward the palm side thus putting pressure on the median nerve. This type of CTC is almost always one-sided.
  • Fibrotic buildup– The most common type of CTS, repetitive movements cause the body to hypertrophy (excessive growth/enlargement/accumulation) and put pressure on the nerves and tendons in the carpal tunnel. The transverse ligament may also swell with chronic irritation that adds to the pressure on the median nerve.

Signs, Symptoms and health issues?

CTS has different levels of severities and symptoms usually are gradual, these may include.

  • Numbness
  • Sensation of pins and needles
  • Pain, particularly at night (Most people sleep with their wrists flexed)
  • Pain originating from the wrist
  • Radiating or referred pain upwards to the arm and shoulder
  • Weakness of the hand
  • Their little finger and half of the ring finger is unaffected.

Sufferers frequently have sensations of burning, tingling or itching numbness in the palms of the hand and fingers, in particular the thumb and the first two fingers. Fingers may feel useless and swollen even though there may be no visible signs apparent, symptoms often appear during the night (due to the wrist being flexed) that you may wake up with the feeling wanting to “shake out your hands or wrists” As the problem develops there may be tingling sensations during the day and decreased strength when gripping. 

 

CTS affects the fine motor skills of your hands, hands that you use every single day and therefore can have a serious impact on your life. From sensations that can be annoying to significant pain that may be a hindrance to your job. Muscle weakness can affect grip strength causing difficulty with grasping small objects or performing manual tasks with your hands. If the condition is chronic and/or untreated the muscles at the base of the thumb may atrophy from the lack of nerve stimulation. 

Treatments?

Treatment for CTS comes in both non-surgical treatments and surgery. The severity of the condition, how long it has degenerate will determine the treatment plan. If the sufferer has any underlying conditions (arthritis or diabetes) this should be treated first. 

The initial treatment is resting the hand that is afflicted for at least two weeks, avoiding any activities that many further irritate the joint, immobilization of the wrist using a wrist splint, this is to keep the wrist in a neutral position and therefore keep the tunnel as open as possible and requires less work for the surrounding muscles. If there is inflammation at the site then the application of a cool pack or ice will help with the swelling. 

  • Medication– Steroids and nonsteroidal anti-inflammatories may be prescribed, non-prescribed pain relievers to treat the pain symptoms. Diuretics can be taken to decrease swelling and the body’s fluid retention. Corticosteroid injections administered to the wrist to reduce inflammation. 
  • Exercise– Stretches to mobilize the tendons that are tight are recommended, these exercises may be supervised by a physical therapist/occupational therapist. 
  • Surgery– This is considered when all prior non-surgery treatments are ineffective, generally after symptoms persist up to six months. The transverse carpal ligament is split and some of the accumulated connective tissue is removed. (Open release surgery) Endoscopic surgery allows surgeons to cut through the transverse ligament from inside the carpal tunnel without further cutting into the rest of the tissue surrounding the carpal tunnel. This type of surgery allows for a shorter recovery time and the reduced risk of the scar tissue accumulating that could lead to a reemergence of symptoms again.
  • Massage– The possibility of massage is dependent on the severity and type of CTS. It is suggested that CTS caused by oedema responds well to massage that focuses on draining the forearm. (Manual Lymphatic Drainage) Fibrotic CTS may or may not respond to massage, it is depending on where the fibrosis is and how large it is.