Carpal tunnel syndrome

Carpal Tunnel Syndrome (CTS) is a common condition that causes pain, numbness, and tingling in the hand and arm. It occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.

Causes of Carpal Tunnel Syndrome

  • Repetitive Hand Movements: Especially if the wrist is bent down or up for prolonged periods.
  • Anatomical Factors: A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel.
  • Nerve-Damaging Conditions: Such as diabetes.
  • Inflammatory Conditions: Rheumatoid arthritis or other conditions causing inflammation.
  • Fluid Retention: Can increase pressure within the carpal tunnel, often seen during pregnancy or menopause or hypothyroidism
  • Workplace Factors: Use of vibrating tools or work that requires prolonged or repetitive flexing of the wrist.

Diagnosis of Carpal Tunnel Syndrome

  • History
    • Symptoms:
      • Numbness, tingling, and pain in the thumb, index, middle, and part of the ring fingers.
      • Complaints of dropping things and weakness.
      • Pain radiating back up forearm, particularly at night
    • Onset and Duration: When symptoms started and their progression.
    • Aggravating Factors: Activities that worsen symptoms, like typing or driving.
    • Medical History: Diabetes, thyroid disorders, rheumatoid arthritis.
  • Physical Examination
    • Tinel’s Sign: Tapping on the median nerve at the wrist to see if it causes tingling in the fingers.
    • Phalen’s Maneuver: Pressing the backs of the hands together to form a right angle to see if this position causes numbness or tingling.
    • Wrist Examination: For swelling, warmth, and deformity.
    • Muscle Testing: Assessing the strength of the hand muscles.
  • Investigations
    • Blood Tests: Particularly for diabetes, hypothyroidism and Rheumatoid Arthritis
    • Nerve Conduction Studies: To measure how fast electrical impulses move through the median nerve.
    • Electromyography (EMG): To check the muscles’ electrical activity.
    • Ultrasound or MRI: To visualize the median nerve or identify anatomical abnormalities.

Differential Diagnosis (DDx)

  • Wrist Arthritis: Similar pain but usually with joint swelling and stiffness.
  • Thoracic Outlet Syndrome: Numbness in the hand, but caused by nerve compression in the neck or shoulder.
  • Cervical Radiculopathy: Nerve root compression in the neck causing similar symptoms.
  • Ulnar Nerve Compression: Affects the ring and little finger.
  • Raynaud’s Phenomenon: Causes fingers to become white, then blue, and feel cold or numb.

Management of Carpal Tunnel Syndrome

  • Non-Surgical Treatment:
    • Wrist Splinting: Especially at night to keep the wrist in a neutral position.
    • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): To relieve pain.
    • Corticosteroid Injections: To reduce inflammation and swelling.
  • Activity Changes:
    • Ergonomic Adjustments: Modifying workstations, keyboards, and tool use.
    • Activity Modification: Avoiding or modifying activities that worsen symptoms.
  • Surgical Treatment:
    • Carpal Tunnel Release Surgery: Cutting the ligament at the top of the wrist to relieve pressure on the median nerve.
  • Physiotherapy:
    • Strengthening and Stretching: To improve wrist and hand function.
    • Nerve Gliding Exercises: To help the median nerve move more freely within the confines of the carpal tunnel.

Conclusion

Early diagnosis and treatment of Carpal Tunnel Syndrome are important to relieve symptoms and prevent permanent nerve damage. Treatment varies from conservative approaches like splinting and activity modifications to surgical interventions, especially in severe cases. Regular follow-up is essential to assess the effectiveness of treatment and make necessary adjustments.