Carpal Tunnel Syndrome (CTS) is a disorder that can be debilitating, extremely painful, and can affect your capacity to sleep, work, and function through a normal day. Here is the latest on CTS.
WHAT IS CARPAL TUNNEL SYNDROME?
Carpal Tunnel Syndrome is the dysfunction resulting from the compression of the median nerve as it passes through the wrist into your hand.
These nerves transmit messages about pain and sensation from your hand and wrist to your brain. They also send message from your head to the muscles in your arm. A ligament called the Transverse Carpal Ligament creates a tunnel through which this nerve passes on the underside of your wrist, keeping it in place. However this tunnel is quite small, so it is possible for the median nerve to be compressed when the contents of the tunnel swell.
CTS is highly over-diagnosed as many other hand and wrist pathologies tend to get labelled as Carpal Tunnel Syndrome. An excellent assessment is important.
SIGNS AND SYMPTOMS
- Pain and/or numbness and tingling in the thumb, 2nd and 3rd fingers, and palm of hand.
- A sensation of swelling and tightness in the wrist and hand (though true swelling is less common)
- Other sensations such as burning, aching, and cramping
- Numbness and pain that disrupts sleep
- Limited mobility of your wrist and fingers
- Weakness and muscle loss of the hand
- Difficulty with repetitive activities involving the fingers, hand and wrist
WHAT CAUSES CTS?
Currently the exact causes of Carpal Tunnel Syndrome are not fully understood. However the following risk factors for CTS are known.
- Activities that result in repetitive wrist, hand, and finger movement, especially gripping combined with wrist movement (e.g. construction workers)
- Direct impact or trauma to the area
- Pregnancy, rheumatoid arthritis, diabetes mellitus, and hypothyroidism
- Excessive use of tools that vibrate
- Existing nerve root compression in your neck (Double crush syndrome)
Surprisingly, studies show that keyboarding does not increase the risk for CTS!
These risk factors can create an increase in pressure or narrow the space inside of the carpal tunnel, which can compress or irritate the median nerve.
Nerve conduction studies or electromyographic tests (EMG) are the most common tools used to test for CTS. However more recent research indicates that these tests are not useful in supporting our clinical diagnoses. There is somewhat better evidence for diagnostic ultrasound, however this requires further research.
The most reliable way to diagnosis CTS is with a thorough clinic assessment by a qualified health professional in combination with imaging.
Treatment for CTS typically involves physiotherapy, splinting, corticosteroid injections, nerve medications such as (Gabapentin) and surgery.
Surgery attempts to release pressure on the median nerve by cutting the transverse carpal ligament. Studies have found this to be more effective than splinting.
Positive benefits have also been found with acupuncture, and manual physical therapy at the wrist bones.
What doesn’t work:
- A recent study has found anti-inflammatories unhelpful and associated with side-effects
- There is no evidence for magnetic therapy or laser treatment
If your symptoms are mild to moderate, your outcome is good with conservative treatment.
If your symptoms are severe enough to have caused muscle wasting, or if you don’t show improvement within 6 weeks of treatment, you’re more likely going to require surgery.
If your symptoms are severe and prolonged, the nerve can scar and result in permanent dysfunction, even with surgery.
If your CTS was pregnancy induced, your symptoms will likely resolve after childbirth.
KEYS TO RECOVERY
Have your symptoms properly assessed. As the first 6 weeks of rehabilitation are important for your long term outcome, make sure you see an expert physiotherapist and follow their treatment recommendations as closely as you can. If you have further questions, please feel free to contact our clinic. We’d love to help.