Carpal tunnel syndrome (CTS) is a conditions caused by the compression of the median nerves beneath the transverse carpal ligament within the narrow confines of the carpal tunnel located in the wrist. The condition is very common and is due to pressure from trauma or edema caused by the inflammation of the tendon, neoplasm, rheumatoid synovial disease, or soft tissue masses.
Symptoms of CTS are more pronounced during the premenstrual cycle, pregnancy, and menopause in women. Diabetes mellitus, or type 2 diabetes, and thyroid dysfunction can aggravate the condition as well by increased fluid retention these diseases cause. Some occupations can cause carpal tunnel syndrome like:
– Hair dressers
– Machine operators
– Other occupations with repetitious hand usage
A person will start feeling weakness, especially in the thumb, when CTS starts affecting the extremity. A burning pain and numbness will be felt or impaired sensation where there will be a sense of “clumsiness” in performing fine hand movements. Numbness and tingling may wake a person at night.
One way to test for CTS is to hold the wrist flexed back for 60 seconds. If a tingling and numbness is felt through the median nerve (center of the inner wrist), and through the palmar surface of the thumb, the index finger, the middle finger, and part of the ring finger, it could be indicative of CTS. It is call Phalen’s sign. If the inflamed median nerve is tapped and it causes prickling or other abnormal sensation, it is called Tinel’s sign and it is also a sign of CTS. In later stages of the CTS, there will be atrophy (decreased muscle mass due to prolonged immobilization) of the muscles around the thumb that results in recurrent pain and eventual dysfunction of the hand.
It is important to seek treatment sooner rather than later. The longer the nerve is compressed, the more pain a person will experience as well as loss of functioning in the hand and wrist. The treatment is more conservative for carpal tunnel syndrome when it is caught early. Seeing an orthopedic physician will be the first step towards healing from this condition.
The treatment for CTS is toward relieving the underlying cause of the compression of the medial nerve. If the condition is caught early, the hand and wrist can be put in a hand splint to prevent movement and give the area a rest. Wearing the splint at night is especially important, so that the wrist stays straight and doesn’t flex for long periods at night. If the cause of the problem is inflammation, a corticosteroid injection may relief the symptoms for up to 6 months.
If the problem persists, the median nerve may need to be surgically decompressed. This is done with a longitudinal division of a ligament under regional anesthesia. The procedure is done in an outpatient patient basis. Another procedure entails an endoscopic carpal tunnel release. Decompression is performed through a small incision with local anesthesia.