Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome (CTS) is a common cause for pain, numbness, and tingling in the hand. It is caused by compression of the median nerve as it travels through the wrist. 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. Carpal tunnel therapy has been proven to increase flexibility and strength as well as relieve your pain.

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.

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.

Common causes and predisposing factors for CTS include1,2:

  • Repetitive strain and prolonged flexion/extension of the wrist, notably from activities such as driving, reading, typing, and holding a telephone
  • Rheumatoid arthritis
  • Diabetes
  • Wrist fracture and associated swelling
  • Pregnancy/oral contraceptive use leading to swelling in the limbs
  • Underlying nerve dysfunctions

Carpal tunnel treatment will reduce pain and promote better function of your hands.

A physician may perform a variety of physical maneuvers or nerve conduction studies to confirm the diagnosis2,3.

The goals of carpal tunnel treatment are to reduce pain, numbness, and tingling, and to prevent loss of motor function or 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 therapy for carpal tunnel syndrome within six 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 cases. Surgery can be performed via open incision or endoscopically.

The prognosis for CTS is good, although a minority of patients, particularly those with advanced CTS, may fail to improve after surgery1.

Additionally, scarring post-surgery can lead to a recurrence of symptoms several months or years later. The most effective carpal tunnel treatment 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.

References:

  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.
  2. Scott, K.R.; Kothari, M.J. (2011). Treatment of carpal tunnel syndrome. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
  3. Hunter, A.A.; Simmons, B.P. (2010). Surgery for carpal tunnel syndrome. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.


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