Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy (pinched nerve) in the upper extremity.

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Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy (pinched nerve) in the upper extremity. The carpal tunnel is an area on the palm side of the wrist where the flexor tendons (they bend the fingers) and the median nerve pass from the forearm into the hand. CTS occurs when pressure builds up in this tunnel, compressing the nerve.

Pressure on the nerve can be caused by swelling of the lining of the flexor tendons (tenosynovitis), joint dislocations, fractures, arthritis or fluid retention. Thyroid conditions, rheumatoid arthritis and diabetes can also be associated with CTS.

CTS signs and symptoms include pain, numbness and tingling mostly in the thumb, index, middle and ring fingers. These symptoms often happen at night. They can also occur during daily activities like driving or talking on the phone. Weak grip and occasional clumsiness can also be seen.

CTS is diagnosed with a detailed history and physical exam. Sometimes X-rays are taken. Electrodiagnostic testing is occasionally done to confirm the diagnosis or check for other nerve problems.

CTS may be relieved without surgery. Treatment options may include a wrist splint at night or during activities that aggravate the condition. A steroid injection into the carpal tunnel can also help.

When the CTS symptoms are severe or don’t improve, surgery may be needed to relieve pressure on the nerve. This is done by cutting the ligament that forms the top of the carpal tunnel on the palm side of the hand. After surgery, tenderness around the scar can last several weeks or months. The numbness and tingling in the hand or fingers may go away quickly or slowly – it may sometimes take up to a year. In severe cases where there has been permanent damage to the nerve, the symptoms may not completely go away after surgery.

Do I Have Carpal Tunnel Syndrome?

Do you have persistent numbness and tingling in your hand and arm? You might have carpal tunnel syndrome, which is the most common compressive neuropathy in the upper extremity, otherwise known as a pinched nerve in your wrist.

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Understanding Carpal Tunnel Syndrome

These are the most common symptoms:

  • Weakness when gripping objects with one or both hands
  • Pain or numbness in one or both hands
  • "Pins and needles" feeling in the fingers
  • Swollen feeling in the fingers
  • Burning or tingling in the fingers, especially the thumb and the index and middle fingers
  • Pain or numbness that is worse at night, interrupting sleep

The symptoms of carpal tunnel syndrome may be similar to other medical conditions or problems. Always see your health care provider for a diagnosis.

Your provider will check your medical history and give you a physical exam. He or she may recommend that you have electrodiagnostic tests on your nerves. These tests are the best way to diagnose carpal tunnel syndrome. Electrodiagnostic tests stimulate the muscles and nerves in your hand to see how well they work.

Your health care provider will figure out the best treatment for you based on:

  • Your age
  • Your overall health and medical history
  • How bad your wrist is right now
  • How well you tolerate specific medications, procedures, or therapies
  • How bad the disease is expected to get
  • Your opinion or preference

Treatment may include:

  • Splinting your hand. This helps keep your wrist from moving. It also eases the compression of the nerves inside the tunnel.
  • Anti-inflammatory medication. These may be oral or injected into the carpal tunnel space. These reduce the swelling.
  • Surgery. This eases compression on the nerves in the carpal tunnel.
  • Worksite changes. Changing position of your computer keyboard or making other ergonomic changes can help ease symptoms.
  • Exercise. Stretching and strengthening exercises can be helpful in people whose symptoms have gotten better. These exercises may be supervised by a physical or occupational therapist.

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