Carpal Tunnel Syndrome (CTS)  is a condition of the wrist which presents with numbness and tingling in the thumb, index, middle and ring  finger in the early stages.  In severe cases it could be pain and/or weakness in the same area.

Anatomy

 

The small bones in the wrist and the ligaments connecting them makes a tunnel, through this tunnel goes some of the tendons to the fingers and a nerve called median nerve. The median nerve takes care of the sensation to the fingers except the little finger and it also helps the fingers and thumb to move.

 

This tunnel is very narrow and tight, so any swelling of the tendons will cause severe compression of the median nerve resulting in symptoms in the hand.

 

Factors that causes the symptoms of CTS:

 

Repeated manual activities

Repeated exposure to vibrations

Acute inflammatory situations like sprain/strain or fracture

Underactive thyroid gland

Pregnancy and secondary water retention (very common in the 2nd and 3rd trimester)

Inflammatory diseases, eg. Rheumatoid arthritis

 

Presentation

 

The early signs of CTS are numbness and tingling in the thumb, index, middle and ring finger at night during sleeping. Patients often complain of waking up at night/early morning with numbness tingling which goes away when they shake/move their hand.  Later these symptoms become more prominent and happen while holding something like a phone, cutting vegetables or typing. As symptoms worsen, patients experience intense pain in the median nerve distribution area with muscle wasting prominent in the thenar muscles which is

the bulky muscle sitting at the base of the thumb which is responsible for thumb movements and a strong grip. Weak grip with weak thumb movements are also symptoms.

Diagnosis

 

Your family doctor or physiotherapist will be able to diagnose CTS from the history and onset/presentation of symptoms. There are orthopedic special tests that can be done easily to confirm the diagnosis. Tests like nerve conduction study, electromyogram or MRI of the wrist will also help in proper diagnosis of the condition.

 

Not all conditions where there is numbness of the hand is CTS. It is very essential to rule out other possible cause of CTS symptoms like; impingement of the median nerve at the neck or elbow, brachial plexus injury, thoracic outlet syndrome or early signs of multiple sclerosis.

 

Treatment

 

Treatment for CTS should be started immediately once your doctor has ruled out other possible causes of similar symptoms. Patients with early stages of carpal tunnel syndrome can be treated conservatively with the use of a wrist brace worn at night, NSAIDs, and physiotherapy. A physiotherapist will help the patients with activity modification, advice on how to use the brace, tendon and nerve gliding, carpal tunnel mobilisation and proper exercises to be done. They can also help you with tips on how to prevent carpal tunnel symptoms from developing.

 

In severe cases, patients will be referred for surgical management to decompress the median nerve at the carpal tunnel.

 

Prevention

 

Proper posture while working, ensuring proper wrist position at work, stretching of the forearm muscles and maintaining the strength/endurance of the forearm muscles, taking frequent breaks while performing repetitive manual activities etc. will help in preventing the CTS from developing. An ergonomic assessment of your work station will enable in maintaining a proper natural position of your wrist at work.

 

 

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet

 

https://www.physio-pedia.com/Carpal_Tunnel_Syndrome

 

 

Carpal Tunnel Syndrome