Carpal Tunnel Syndrome

CTS can be classified into two main types:

• Primary idiopathic CTS develops without a clear cause.
• Secondary CTS occurs because of another problem, such as an old wrist fracture, repetitive hand use, or medical conditions such as diabetes or thyroid disease.

The symptoms of CTS usually start gradually and may include:

• Numbness and tingling in the thumb, index finger, middle finger, and part of the ring finger. This often feels worse at night affecting sleep, especially at night.
• Pain that may spread up into the forearm or shoulders.
• Weakness and atrophy (shrinkage) in the hand, making it harder to grip objects. 
   

Several factors can increase the risk of developing CTS:

• Women are more likely to develop CTS than men.
• A family history of CTS may increase risk.
• Old wrist injuries, such as fractures, can narrow the tunnel space.
• Repetitive wrist movements, such as typing or assembling line work, can strain the nerve.
• Associated medical conditions, such as diabetes, obesity, hypothyroidism, pregnancy, and rheumatoid arthritis.
   

Doctors usually diagnose CTS by examining symptoms and testing nerve function. Common method include:

• Tinel’s sign, when tapping the wrist causes tingling in the fingers.
• Phalen’s sign, where bending the wrist triggers numbness or pain.
• Checking muscle strength and looking for signs of muscle loss in the hand.

Sometimes additional tests may be needed:

• Radiography (X-ray) to check for old wrist fractures.
• Ultrasound can show changes in the carpal tunnel anatomy and help understand the probable cause of nerve compression.
• Electromyography (EMG) and nerve conduction velocity (NCV) to measure the electrical signals along the nerves of the hand and wrist. EMG and NCV are usually performed simultaneously.
• Magnetic resonance imaging (MRI) is rarely needed but may be used to rule out unusual causes.
   

Based on the intensity of symptoms, the following treatment(s) may be recommended:

• Non-surgical approaches: These may be helpful in mild or early cases and can include:
  • Wrist splints help keep the wrist straight, especially at night.
  • Adjusting work habits and ergonomics to reduce strain.
  • Medicines, such as anti-inflammatory drugs or oral or intravenous steroids.
  • Corticosteroid injections into the wrist to reduce swelling.
• Surgical treatment: In advanced cases or when non-surgical treatments are not effective, the following surgical approaches are recommended:
  • Cutting the ligament that presses on the median nerve (carpal tunnel release).
  • Endoscopic approach also known as keyhole surgery.

Patients are advised to visit their doctor when they notice persistent numbness, tingling, or pain in the hand, if the symptoms disturb their sleep, or if they find it difficult to grip objects.

CTS cannot always be prevented, but you may lower your risk by:

• Taking regular breaks if you do repetitive tasks with your hands.
• Using comfortable well-designed tools and correct posture at work.
• Keeping your wrist straight instead of bending it too much.
• Managing medical conditions like diabetes and thyroid disease.

If you suspect CTS, you should consult an orthopaedic surgeon or a hand specialist. A neurologist may also be involved in diagnosis. A physiotherapist or occupational therapist can help with exercises, splinting, and ergonomic advice.