Here, in this article, I will discuss everything about carpal tunnel syndrome, right from its causes, symptoms, diagnosis, and treatment to prevention, tests, and every other related and useful information.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome, sometimes abbreviated as CTS, is the compression of the median nerve as it passes into the hand.
The median nerve provides sensation to your thumb, long finger, index finger, and half of the ring finger. The carpal tunnel is a narrow passageway that is formed by the multiple bones in the wrist and the transverse carpal ligament. The median nerve runs through this carpal tunnel.
It is a potentially debilitating disorder that can set in gradually or come on suddenly and lead to pain, numbness, tingling, and weakness of the hand and wrist. This disorder can occur in one or both of your hands.
Carpal tunnel syndrome can result from one or more reasons resulting in pressure on the median nerve and dysfunction, like:
- Inflammation and enlargement of the median nerve,
- Thickening of the transverse carpal ligament
- Inflammation and enlargement of the tendons, or
- Presence of a mass lesion (for example, a tumor) within the carpal tunnel
This disorder can also be caused by diseases like diabetes and hypothyroidism or by pregnancy.
Heavier individuals are also more likely to develop carpal tunnel syndrome due to the increasing weight of the arm and hand. This disorder may affect women three times more than men. Patients of this condition are typically middle-aged or older; however, younger people also can get CTS.
What Are The Causes Of Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is a common disorder caused by compression of the median nerve at the wrist. The median nerve travels down the upper arm, across the elbow, and into the forearm, and then passes through a passageway called (the carpal tunnel) at the wrist on its way to the hand and fingers. It gets separated into several smaller nerves along the way, particularly once it reaches the palm.
The median nerve provides:
- Sensation to the palm side of your thumb, long finger, index finger, and half of the ring finger
- Nerve signals to move the muscles around the base of the thumb
The carpal tunnel is a narrow passageway formed by the multiple bones in the wrist and the transverse carpal ligament. This tunnel contains tendons and the median nerve.
Carpal tunnel syndrome (CTS) occurs when there is pressure on the median nerve.
This syndrome is usually caused by repetitive stress on the wrist (for example, typing, using a mouse, or playing tennis).
The most common causes of Carpal tunnel syndrome (CTS) are:
- Frequent, repetitive, small movements with the hands (such as typing a keyboard, using a mouse, or playing tennis)
- Joint or bone disease (such as osteoarthritis or rheumatoid arthritis)
- Frequent, repetitive, grasping movements with the hands (such as with certain physical activities or sports)
- Repetitive strain injury to tendons and ligaments in the wrist from gripping objects too tightly or lifting heavy objects
- Weakness of one side of the wrist can lead to poor balance and overuse of the other hand
- Hormonal changes, such as during pregnancy, can sometimes affect connective tissues and put pressure on the nerve
- Hypothyroidism or an underactive thyroid gland (thyroid gland not producing enough hormones)
- Obesity
- Changes in blood sugar levels (may be seen with type 2 diabetes)
- Family history of carpal tunnel syndrome
- Prolonged exposure to vibrations from using hand tools or power tools
- Sometimes, certain medications can cause it, particularly breast cancer treatments exemestane and anastrozole
- Other conditions or injuries of the wrist (such as sprain, strain, dislocation, fracture, or swelling and inflammation)
What Are The Symptoms of Carpal tunnel syndrome?
The symptoms of carpal tunnel syndrome generally start slowly and can occur at any time.
Early Symptoms of Carpal Tunnel Syndrome
Some of the early symptoms of carpal tunnel syndrome include:
- Pain or/and tingling in the thumb and the two fingers next to it (index and middle fingers), as well as in half of the ring finger
- Numbness at night
These symptoms may extend to the rest of the hand and into the forearm.
The symptoms of carpal tunnel syndrome may initially appear at night or when you wake up in the morning. Shaking your hand around or hanging it out of bed will often help reduce the pain and tingling. The wrist pain may wake them repeatedly during the night.
You may not experience the problem at all during the daytime, but some activities like typing, writing, or housework, can bring on your symptoms.
Common Daytime Symptoms of Carpal Tunnel Syndrome
Though, if the nerve is badly pressed, you might have symptoms throughout the day. Common daytime symptoms of carpal tunnel syndrome include:
a) Facing difficulty in using hand for some small tasks such as
- Using a computer keyboard, or mouse
- Writing
- Holding a book to read.
- Grasping a steering wheel to drive.
- Handling small objects.
b) Reduced feeling in the fingertips
c) Tingling in the fingers
Symptoms of Carpal Tunnel Syndrome When It Gets Worse
The symptoms become more constant as carpal tunnel syndrome gets worse. During this period, symptoms may include:
a) Dropping objects.
b) Inability to perform tasks that require delicate motions, for example buttoning a shirt.
c) Weakness in the hand.
When carpal tunnel syndrome becomes more critical, the size of the muscles at the base of the thumb shrinks a lot in size which is easily visible.
How to Diagnose Carpal Tunnel Syndrome?
Your doctor can diagnose carpal tunnel syndrome by using a combination of your history, a physical examination, and tests for CTS.
History of Symptoms
Your doctor will ask you to describe your symptoms. Then he or she will review the pattern of your symptoms. For example, symptoms in the little finger may indicate a problem other than carpal tunnel syndrome, as the median nerve doesn’t provide sensation to this finger.
Physical Examination
Physical examination helps to diagnose carpal tunnel syndrome in a person. It includes:
- A detailed evaluation of your wrist, hand, shoulder, and neck to rule out any other causes of nerve pressure
- Your doctor will look at your wrists for signs of swelling, tenderness, and any deformities
- He or She will also test the strength of muscles in your hand as well as the sensation of your fingers
- Many times the symptoms may get triggered by simply pressing on the nerve, tapping on it, or bending the wrist
Tests for Carpal Tunnel Syndrome
The health care provider may also perform some tests to detect certain conditions related to carpal tunnel syndrome.
These tests include:
| Tests | How is it done | What it detects |
| Tinel’s Test or Tinel’s sign | Doctor taps over the median nerve at the wrist | Whether the tingling sensation or numbness in one or more fingers is present. |
| Phalen’s Test or Wrist-Flexion test | The health care provider will ask you to press the backs of the hands against each other so that the wrist is bent. You need to stay in the same position for 1 to 2 minutes. | If tingling or numbness occurs within 60 seconds, then there may be damage to the median nerve. The more quickly symptoms appear, the more severe the carpal tunnel syndrome. |
| Two-Point discrimination test | In this test, the healthcare provider will ask you to close your eyes and use a gadget called a two-point discriminator (a small, flat, 8-sided tool with needle-like prolongs sticking out from all sides), or calipers. They will start with two points touching your skin a few centimeters apart and move them closer together until you feel just one point of pressure. | Figure out nerve function and compression. |
| Nerve Conduction Study | The doctor places small electrodes on the hand and wrist. Then small electric shocks are applied. | This test measures how quickly the nerves transmit the signals to the muscles. It can detect when a nerve is not conducting its signal effectively. It can also help your doctor to determine how severe your problem is and help to guide treatment. |
| Electromyography (EMG) | The doctor inserts a thin needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. | Measures the tiny electrical discharges produced in muscles. It can also identify damage to the muscles controlled by the median. The test also may help to rule out other conditions. |
| X-ray | It provides images of dense structures, such as bone. | To rule out other causes of symptoms such as fracture, or arthritis. |
| Ultrasound | It uses high-frequency sound waves for creating pictures of bones and nerves. | Helps to determine whether the nerve is being compressed. |
| Magnetic resonance imaging (MRI) scan | It gives better images of the body’s soft tissues than X-rays. | It helps your doctor to determine other causes of your symptoms. It can also help to determine if there are problems with the nerve itself, such as scarring from an injury or a tumor. |
What Are The Risk Factors For Carpal Tunnel Syndrome?
Carpal tunnel syndrome can occur to anyone at any time of life but there are various factors that have been associated with this condition. Though they may not directly cause this syndrome, they may increase your risk of damage or irritation to the median nerve.
The risk factors for carpal tunnel syndrome may include:
Gender
This condition is generally more common in women. This may be because of the relatively smaller carpal tunnel areas in women than in men.
Women suffering from this condition may also have smaller carpal tunnels than women who don’t have this condition.
Age
People between 40 to 60 years of age are at an increased risk of carpal tunnel syndrome.
Workplace Factors
People working with vibrating tools or on an assembly line in industries (such as food processing, cleaning, sewing, and manufacturing) that require repetitive flexing of the wrist may create harmful pressure on the median nerve, especially if the work is done in a cold environment.
Acromegaly
It may lead to swelling of the median nerve, due to which the risk of compression increases.
Hypothyroidism
This condition can cause fluid retention which may result in deposits on the median nerve.
Obesity
Obesity increases the risk of carpal tunnel syndrome.
Conditions that lead to fluid retention
Conditions such as kidney failure, menopause, or pregnancy can cause fluid retention, leading to an increased risk of this disorder.
Inflammatory conditions
Certain inflammatory conditions such as rheumatoid arthritis also increase the risk.
Anatomic factors
Anatomic factors are also responsible for developing this condition. Such factors include being born with a tiny wrist, a small carpal tunnel, etc.
Conditions that damage nerves
Certain conditions like diabetes damage nerves and thus may also affect the median nerve leading to an increased risk of this disorder.
Wrist injury
Wrist injuries such as a severe bruise, burn, fracture, or dislocation of the lower arm or wrist may result in swelling in the carpal tunnel.
Exposure to vibration
It is seen as the minor cause of carpal tunnel syndrome.
What is The Treatment Of Carpal Tunnel Syndrome?
Treatment of carpal tunnel syndrome aims to relieve symptoms and slow down its progression by reducing pressure on the median nerve.
There are many options available for the treatment of carpal tunnel syndrome. In the initial stages, some self-care tips, medications, yoga, and hand therapy techniques may be effective in treating this condition. Whereas, when the condition worsens the doctor may recommend surgery to treat the condition.
Let’s discuss all the options available for treating carpal tunnel syndrome.
Self-Care Tips
The following tips may help you to reduce discomfort:
Applying cold compresses
To reduce pain and inflammation during a flare-up, you may apply the ice or cold pack to the affected area. One session should be limited to 10 to 15 minutes. You can opt for the number of sessions according to your comfortability.
Resting the hand and wrist
The more rest your hand and wrist will get, the greater will be the chance of relieving the symptoms.
Hang your hand while sleeping
Gently shake the wrist or hang it over the side of the bed to deal with the pain during sleeping.
Using occupational therapy
A therapist can teach you how to carry out repetitive tasks differently.
Manage the triggers
If the cause of your CTS is repetitive hand movements, then you should try to take breaks during movements that trigger the symptoms so that your hand and wrist have time to rest and recover.
Putting Hand in Warm Water
Experts also suggest that to deal with the pain of carpal tunnel syndrome, you can try putting your hand in warm water. After that gently flex and extend the wrist and hand. One can do it a maximum of 3 to 4 times a day.
OTC Pain Relievers
The pain of carpal tunnel syndrome can be reduced by taking over-the-counter pain relievers such as ibuprofen, or aspirin.
Wearing Wrist Splints
Wrist splints keep the wrist in the same position and prevent it from bending. They can be worn during sleep, as well as during waking hours if they do not interfere with daily activities. A wrist splint can help relieve nighttime symptoms of tingling and numbness. Although you only wear it at night, it can also help prevent daytime symptoms.
Usage of a wrist splint may be a good option if you are pregnant as it doesn’t involve the use of any medicine.
Wrist splints are available over the counter at pharmacies. Your doctor can advise you about the best one to choose.
These methods can help you to relieve the symptoms but they are not useful for fully curing the condition. These may be useful for short-term relief. Whereas, if they don’t prove to be helpful, you can try other treatment options.
Tweak Your Activities
Carpal tunnel syndrome is the condition that is developed when keeping the wrist and hand in one position for a long time. Tweaking such activities can be used as a treatment, like
- Take a break from work per hour and remember to stretch your hands
- Ask your manager about the possibility of altering the workstation setup, tools, or desk
- Try alternating the hands while doing the tasks, so that it does not put pressure on one hand
- Only put the required amount of force. Do not pound away at your keyboard or hold the tools too tightly
Medications For Carpal Tunnel Syndrome
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs, such as diclofenac, may help relieve short-term pain from carpal tunnel syndrome. However, there is no evidence that these drugs can improve this syndrome.
Corticosteroids
Your doctor may also recommend corticosteroids such as cortisone to reduce inflammation and swelling which in turn relieves pressure on the median nerve.
Corticosteroids can be given as an injection directly into the wrist, but they can also be given orally.
The doctor may inject the carpal tunnel with a corticosteroid to relieve pain; sometimes using an ultrasound to guide these injections.
For treating carpal tunnel syndrome, oral corticosteroids are not considered as effective as corticosteroid injections.
Continued use of corticosteroids is also not recommended, due to the occurrence of long-term side effects.
Surgery For Carpal Tunnel Syndrome
Surgery may be recommended when:
- Carpal tunnel syndrome does not respond to non-surgical treatments
- The condition has already become severe, or
- There is severe damage to your median nerve
The goal of carpal tunnel surgery is to reduce pressure by cutting the transverse carpal ligament pressing on the median nerve.
Duration of symptoms, age of the patient, and diabetes mellitus are some of the factors that determine the success or failure of surgery.
There are two main types of carpal tunnel syndrome surgery (1):
- Open surgery
- Endoscopic surgery
Open surgery
Open surgery is a more traditional CTS surgery, in which your surgeon makes a small incision in the wrist and cuts the carpal ligament to enlarge the carpal tunnel.
Endoscopic surgery
In endoscopic surgery, your surgeon makes small incisions in the wrist and palm. Then the surgeon will insert a tiny camera into the wrist to look inside the carpal tunnel and cut the carpal ligament.
It can take several months to fully recover, but you may find relief right after surgery.
Alternative Therapies For Carpal Tunnel Syndrome
Including alternative therapies in your treatment plan can be helpful in coping with carpal tunnel syndrome. But you should always consult your doctor before trying any alternative therapy.
Physical And Occupational Hand Therapy
Physical and occupational hand therapy techniques may be helpful to treat the condition. A therapist can suggest some stretches and exercises for strengthening your wrist and hand muscles.
Yoga
Yoga postures considered for stretching, strengthening, and balancing the upper body and joints can be helpful to boost grip strength and ease the pain.
Ultrasound therapy
In this treatment, the temperature of the affected area is raised with the help of high-intensity ultrasound. This helps in healing the condition and relieving pain.
Acupuncture
In some cases, acupuncture can also be helpful to treat the pain, inflammation, or any other symptoms caused by carpal tunnel syndrome.
Prevention of Carpal Tunnel Syndrome
It is difficult to prevent carpal tunnel syndrome.
There are many different activities in an individual’s life that can lead to this condition. Preventive measures in every such condition can be different and challenging.
Some prevention techniques like wrist and hand placement, proper seating, etc. can help to decrease some risk that can lead to carpal tunnel syndrome.
Preventive measures to minimize stress on the hands and wrists may include:
1) Carefully monitor and treat the medical conditions associated with carpal tunnel syndrome, for example, maintain proper blood glucose levels to help prevent the complications of diabetes
2) Perform stretching and conditioning exercises before and after activities.
3) Don’t overbend your wrist, for example, all the way down or up
4) Take frequent rest breaks between repetitive activities.
5) Decrease repetitive or strong grasping with your wrist in a flexed position.
6) Maintain correct posture to prevent putting undue strain on the hands and wrists
7) Avoid flexing and extending your wrists repeatedly.
8) Keep your wrists straight while using the tools.
9) Sleep with your wrists held straight.
What is the outlook for People with Carpal Tunnel Syndrome?
Early treatment of your carpal tunnel syndrome with lifestyle changes and physical therapy can result in significant long-term improvement, and help eliminate symptoms.
Mild to moderate forms of CTS can be treated with home remedies, lifestyle changes, physical therapy, and medications. But its more severe forms may require steroid injections or even surgery.
If a person with this syndrome doesn’t receive treatment, over time, CTS can lead to permanent nerve damage, serious pain, and loss of hand function.
Early diagnosis and proper treatment can bring relief sooner and avoid complications in people with carpal tunnel syndrome.
Summary
Carpal tunnel syndrome is a common condition caused by pressure on the median nerve as it passes into the hand. It causes pain, tingling, and numbness in the palm of the hand and the fingers, especially the thumb and the index finger.
This pressure can result from repetitive hand movements or injury to the wrist. Pain typically worsens after some activities (like typing, writing, or housework) or sleeping. Treatment options varied depending on the particular condition.
In severe cases, surgery may be needed. People with this syndrome should work to keep their wrists as relaxed as possible. This can help ease symptoms and reduce pain. Carpal tunnel syndrome is usually treated with medication or surgery but should not be taken lightly.
Seek medical attention if you have persistent pain, swelling, or tingling in the hand that does not go away with rest.
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References:
1) Carpal Tunnel Syndrome Fact Sheet
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Disclaimer
This article is intended for informational purposes only. Any information associated with this article should not be considered as a substitute for prescriptions suggested by local health care professionals.
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