Carpal tunnel syndrome (CTS) is a common progressive nerve condition that affects the hand and wrist. It typically causes numbness, tingling, and pain in the hand’s thumb and first three fingers. The condition is commonly associated with repetitive hand and wrist movements as part of work, sport, or hobby.

While anyone can develop carpal tunnel syndrome, the prevalence is higher amongst women and mostly occurs between the age of 30 and 60 years. People with mild symptoms of the condition are effectively treated with splints, medications, or self-management techniques. However, severe cases may require a simple surgical procedure.

Understanding more about carpal tunnel syndrome

The carpal tunnel is a narrow passage in the wrist made up of eight small wrist bones. The median nerve is one of the major nerves of the forearm and hand. It enables movement and provides sensation to the palm, thumb, index finger, middle finger, and half of the ring finger (towards the thumb). This median nerve enters the hand through the carpal tunnel. The tendons that help to bend the thumb and fingers also pass through the carpal tunnel. However, the tissues surrounding the tendons called the synovium may swell due to the repetitive use of hands. This swelling within the carpal tunnel may lead to compression or squeezing of the median nerve causing carpal tunnel syndrome.

Symptoms of carpal tunnel syndrome

The symptoms of carpal tunnel syndrome begin gradually and can appear in one or both hands. Many people may not even notice the symptoms in the initial stages as they are not felt when using the hands, instead, they appear when the hand is at rest, during the night.

Early symptoms

• Numbness during the night
• Pain and tingling sensation in the fingers

In the early stages, people with carpal tunnel syndrome often wake up from sleep with numbness in their hands and they find relief on shaking their hands.

Day time symptoms as the condition progresses

• Tingling sensation in the fingers
• Reduced sensation in the fingers, especially the fingertips
• Difficulty performing small tasks with hands such as:

• Holding small objects, or a phone, newspaper, and writing
• Gripping a steering wheel when driving
• Using a computer keyboard and mouse

Constant symptoms when carpal tunnel syndrome worsens

• Weakness in the hand and wrist
• Dropping objects because of weakness, numbness, or loss of awareness
• Inability to perform simple everyday tasks such as buttoning a shirt

Risk factors of carpal tunnel syndrome

Activities that involve repetitive use of fingers and certain motions increase the risk of developing carpal tunnel syndrome. These include:

• Repetitive motion involving high force such as hammering
• Long-term use of hands and fingers
• Prolonged or repetitive wrist movements
• Vibration while working with vibrating tools

Other factors involved include:

• Hormonal changes during pregnancy or menopause that cause fluid retention increasing the pressure within the carpal tunnel
• Gender, as the carpal tunnels tend to be smaller in women
• Diabetes can cause nerve damage, including the median nerve
• Bone or joint diseases such as arthritis, osteoarthritis, or rheumatoid arthritis
• A family history of the smaller carpal tunnel area
• An injury to the wrist (fracture, sprain, strain, dislocation, or swelling)
• Being overweight, which causes an increased fluid accumulation in the tissue spaces in the carpal tunnel.

Diagnosis of carpal tunnel syndrome

The doctor primarily reviews the pattern of symptoms and performs a physical examination.

Physical examination includes:

• Tinel’s sign: The test involves tapping over the affected nerve on the palm side of the wrist to see if it causes pain that radiates from the wrist to the hand.
• Phalen test: While resting the elbows on the table, the wrist is bent forward freely. In a positive test, the symptoms of numbness, tingling, or weakness will result within 60 seconds.

Other tests include X-rays to rule out other conditions such as arthritis and nerve tests to determine the function of the median nerve.

Treatment and management of carpal tunnel syndrome

In the early stages, carpal tunnel syndrome can be treated by taking simple steps such as:

• Resting the hands by taking frequent breaks
• Avoiding activities that worsen the symptoms
• Applying cold packs to help reduce the swelling.

Non-surgical treatment

In the case of mild to moderate carpal tunnel syndrome, a combination of non-surgical modalities is recommended that include:

• Wrist splint: Wearing a splint at night will help prevent wrist movement, easing the nerve compression in the carpal tunnel. This helps relieve night time symptoms such as tingling and numbness.
• Medications
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief.
  • Corticosteroid injections to decrease inflammation and swelling. This relieves pressure on the median nerve and eases pain.
• Activity or worksite changes: Changing activities that aggravate the symptoms and ergonomic modifications help stop or slow down disease progression.
• Exercises: Stretching and strengthening exercises of the hand may be beneficial as they help the median nerve to move freely within the carpal tunnel.

Surgical treatment

Surgery may be recommended in the case of severe symptoms or if the condition does not respond to other treatments. The procedure involves easing compression on the nerves in the carpal tunnel.

Conclusion

As carpal tunnel syndrome is associated with a modern lifestyle involving sedentary habits and extensive computer use, it is important to understand the early signs. Carpal tunnel syndrome can progress and worsen if neglected, interfering with normal daily activities. Hence, it is vital to consult the doctor as soon as the symptoms develop. Though one cannot always prevent the condition, certain lifestyle modifications can help, particularly in people whose everyday activities are related to a higher risk of developing carpal tunnel syndrome. It is essential to take frequent rest breaks, stretch, change positions, maintain correct posture and wrist position.

For any questions on musculoskeletal health, you can talk to an orthopaedician.