Carpal tunnel syndrome (CTS) is a condition that causes pain, numbness and tingling in the fingers and hands. It is caused by compression of the median nerve in the wrist.
One or more fibers that transmit signals of sensation and motion between the brain or spinal cord and other parts of the body.
The median nerve sends nerve fibers to the palm side of the thumb, the index and middle fingers, as well as half of the ring finger.
CTS occurs because the median nerve is compressed in a narrow area at the base of the hand called the carpal tunnel. The carpal tunnel lies between the bones of the wrist (situated towards the back of the hand) and the transverse carpal ligament (which lies towards the palm).
As well as the median nerve, many of the tendons that help move the fingers also run through the carpal tunnel. Any swelling in this area can lead to compression of the median nerve, which can interfere with the normal transmission of signals along the nerve.
The carpal tunnel is formed by the transverse carpal ligament and bones of the wrist.
Short, flexible fibrous tissue that connects the bones and cartilage of joints.
One or more fibers that transmit signals of sensation and motion between the brain or spinal cord and other parts of the body.
People between 30-60 years of age are at greater risk of developing CTS. It is also more common in women.
In many cases, it is not clear why compression of the nerve occurs. However, there are several factors that can be associated with an increased risk of developing CTS:
A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterized by high blood sugar levels. Also known as diabetes mellitus.
One or more fibers that transmit signals of sensation and motion between the brain or spinal cord and other parts of the body.
Symptoms of CTS include:
Symptoms mostly affect the thumb and the first three fingers, but can include the whole hand and spread up the forearm or past the elbow towards the shoulder. One or both hands can be affected.
Symptoms tend to:
There is no one single test for CTS.
Your doctor will ask about your symptoms and may perform some physical tests to better gauge how extensive your symptoms are.
These tests are designed to see if symptoms occur when:
It is important to note that not all people with CTS have symptoms when these tests are performed, so while they can be helpful in making a diagnosis, they do not always give a clear indication of whether you have the condition or not.
If it is not clear whether CTS is the cause of your symptoms, or it is suspected that you may have an underlying medical condition, further tests may be recommended.
These include:
Blood tests can help to identify conditions such as arthritis, diabetes and hypothyroidism that are associated with an increased risk of developing CTS.
CTS can reduce the speed at which nerve signals travel along the median nerve. By placing electrodes on the wrist and hand, a nerve conduction study can measure this.
Electromyography (EMG) tests the function of the median nerve by inserting fine needles through the skin in order to measure electrical activity in the muscles of the hand.
Imaging techniques such as X-ray, magnetic resonance imaging (MRI) and ultrasound may be recommended, but they are often not required for a diagnosis of CTS. They can sometimes help to identify underlying causes such as fractures and rheumatoid arthritis.
A metabolic disorder that is caused by problems with insulin secretion and regulation and which is characterized by high blood sugar levels. Also known as diabetes mellitus.
A type of imaging that uses a magnetic field and low-energy radio waves, instead of X-rays, to obtain images of organs.
One or more fibers that transmit signals of sensation and motion between the brain or spinal cord and other parts of the body.
A scan that uses ionizing radiation beams to create an image of the body’s internal structures.
Some mild cases of CTS may get better without treatment. If symptoms continue to get worse, seeking treatment can prevent irreversible damage to the median nerve that can occur with severe, long-standing CTS.
Taking steps to rest your affected hand and avoid activities that can make the CTS worse are an important part of dealing with CTS.
This can involve:
An occupational therapist may be helpful in reviewing your activities either at home or in your workplace and suggesting ways you can adapt what you do, so that you have less pain and are less likely to further damage the nerve. They may also suggest products that can be helpful if you are having difficulty with some activities.
A wrist splint.
In severe cases of CTS, where other treatments have not proven effective, carpal tunnel release surgery may be recommended.
In carpal tunnel release surgery, the transverse carpal ligament is cut in order to decrease pressure on the median nerve. Over time the ligament heals, but because this involves the formation of scar tissue, it will not be so tight and should increase the amount of room in the carpal tunnel.
Carpal tunnel release surgery:
Depending on the type of surgery you have, whether or not the hand operated on is your dominant (or writing) hand, and the type of activities you do at work, it can take several weeks to recover and regain full use of your hand. Full healing of the area may take months and you may be directed to regularly perform some simple hand exercises to help promote recovery.
Surgery is often very successful, providing a permanent cure. However, if the median nerve has been compressed for a long time and is therefore more damaged, this may be less likely. Your doctor can discuss whether carpal tunnel release surgery may be suitable for you.
A medication that resembles the cortisol hormone produced in the brain. It is used as an anti-inflammatory medication.
A body’s protective immune response to injury or infection. The accumulation of fluid, cells and proteins at the site of an infection or physical injury, resulting in swelling, heat, redness, pain and loss of function.
Short, flexible fibrous tissue that connects the bones and cartilage of joints.
A type of medication that, when administered to an area, creates a localized loss of sensation by blocking nerve activity.
One or more fibers that transmit signals of sensation and motion between the brain or spinal cord and other parts of the body.
A minimally invasive type of surgery that uses small incisions through which thin instruments and a slender camera are passed to view and perform surgery on internal tissues.
If CTS is not treated and continues to get worse, irreversible damage can occur to the median nerve. Over time this can lead to wastage of some of the muscles in the hand, resulting in reduced function of the hand.
Complications can occur following carpal tunnel release surgery and your doctor can discuss these with you.
Complications can include:
In rare cases, CTS symptoms can come back years after surgery.
Entry into the body of microorganisms that can reproduce and cause disease.
Short, flexible fibrous tissue that connects the bones and cartilage of joints.
One or more fibers that transmit signals of sensation and motion between the brain or spinal cord and other parts of the body.
The nerve that supplies nerve fibers to the some of the skin and muscles of the hand.
CTS symptoms often improve with rest and medication, but it is not uncommon to require surgery. Treatment of underlying medical conditions can help to reduce symptoms.
Surgery for CTS is often very successful.