By: Sergio Rodriguez, MD
DHR Health Hand and Wrist Institute
Carpal Tunnel Syndrome (CTS) is the most common compressive neuropathy (pinched nerve) in the human body. It is caused by pressure of the inflamed soft tissue against the median nerve within the carpal tunnel. The carpal tunnel is located in our wrists where the tendons, along with the median nerve, pass through to reach the hand.
CTS symptoms include numbness and tingling in the hand. Typically the thumb, index finger, long finger, and part of the ring finger become numb. Carpal tunnel syndrome can also present as pain or a burning sensation in the hand. Symptoms are frequently more noticeable after lying down and very often cause the patient to awaken from their sleep to shake their hands and relieve the tingling. The pain caused by the pinched nerve is sometimes very severe, not allowing the patient to sleep through the night.
Sometimes people feel clumsy and can frequently drop objects. Dropping objects may be caused by losing the ability to feel the object that you are holding. Carpal tunnel syndrome can make small simple tasks such as, picking up a coin or buttoning a shirt, difficult. In advanced cases, weakness and even muscle wasting can develop in the hand.
The most common cause of carpal tunnel syndrome is repetitive motions or activities involving the hands. Traditionally, CTS was thought to only affect the people that used typewriters day in and day out, however, we now have realized that any repeated manual activity can predispose the development of CTS. Typically women are affected more often than men. CTS is also more common in diabetic patients, obese patients, patients with hypothyroidism, pregnant women, patients with arthritis, and patients with renal failure.
The diagnosis of carpal tunnel syndrome is typically made through a physical exam by your doctor. Sometimes a nerve study may be necessary (electromyogram and nerve conduction velocity). There are other problems that can manifest themselves with pain, numbness, or weakness of the hands which is why it is important to always be evaluated by a physician.
The treatment for CTS depends on the severity of the disease. Typically, nonoperative management is initiated. This includes night splints, activity modifications, and hand exercises. If these fail to improve the symptoms, then a steroid injection into the wrist, may be performed.
If conservative, or nonoperative treatment fails, then surgery is usually recommended. There are two forms of surgery, the traditional open form and the more modern endoscopic technique. The long-term results are the same regardless of the type of surgery performed, however, the endoscopic carpal tunnel release has the advantage of being less aggressive on the body and allows for a quicker recovery from surgery.