Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a painful syndrome that involves the hand, wrist and sometimes arm. It is seen more often in women than men and usually occurs between 40 and 60 years of age. Several nerves travel from the spine, down the arm and into the hand which allows fine movements of the hand and fingers (i.e. handwriting, buttoning and fine coordination). One of these nerves, called the median nerve, is the one most affected in CTS. The median nerve travels through a very small space at the wrist, called the carpal tunnel. The nerve is surrounded by the carpal ligament, which is a thick band of fiber that gives strength and support to the wrist and hand. When this carpal ligament hardens, the nerve is pressed into the small space of the carpal tunnel. The nerve then becomes trapped in the tunnel, causing the symptoms you may experience.

Signs and symptoms

Numbness in the hand and/or fingers which often occurs at night and may awaken the person from sleep.
Pain in the hand and/or wrist which often occurs with use of the hand. The pain is usually described as aching or burning.
Numbness in the fingertips which may feel like "pins and needles" or tingling.

Causes

Repetitive motion of the hand or fingers (i.e. typing, carpentry and factory line work).
Injury to the hand or wrist.
Being overweight.
Sometimes occurs during pregnancy (will usually resolve after pregnancy).
People with diabetes may have CTS.

Diagnostic tests

If your health-care provider suspects you have CTS, the following tests may be performed:

Tinnels test
This simple test is done in the office and is performed by gently tapping the area over the nerve. The test is positive if the tapping causes pain in the hand and/or wrist.
Phalen's test
This simple test is done in the office and is performed by asking the patient to flex the wrist in a certain position. If this position causes or reproduces the pain, the test is positive.
Electromyogram (EMG) and Nerve Conduction
These tests use small needles to test the amount of time it takes for the stimulus (pinprick) to get a response. The more delayed the response, the greater chance of having CTS.

Treatment

Use of a wrist splint
Your health-care provider may prescribe a splint to keep your wrist and hand in the proper position while adding support to the carpal ligament. The splint is especially helpful if worn during sleep.
Injections of steroid into the tunnel space
May help to reduce the inflammation temporarily.
Surgery
In some cases, a special scope, called an endoscope, can be used to release the nerve. In other cases, a minor surgical procedure is indicated, involving a small incision in the palm and wrist to release the medial nerve from the trapped space. This is usually done in outpatient surgery, and the patient may go home the same day. The hand may (or may not) be placed in a splint, with a large dressing over the hand and wrist. Following surgery, it is important to keep the hand elevated and avoid any strain on the fingers, hand or wrist. Move the fingers and thumb frequently to keep the muscles strong and flexible. The dressing should be kept dry and clean until removed by the health-care provider (about three to four days). The hand should be kept dry until the stitches are removed in about 14 days. Avoid any injury or strain on the incision even after the stitches are removed.

Reducing the risk

If you have a job that requires repetitive motion with the hands, make sure your wrists and arm have adequate support.
Perform frequent wrist exercises such as rotating the hand 10 times every hour or squeezing a small rubber ball several times per day.
Avoid injury to the wrist or hand (i.e. wear protective equipment when roller-skating).
Try using a wrist support at the keyboard or typewriter if you type often.
If you are diabetic, try to keep your blood sugar under adequate control.