Overview of Carpel-Tunnel-Syndrome

Carpal tunnel syndrome (CTS) is a condition resulting from the compression of the median nerve that runs from the forearm into the hand. This nerve lies within the carpal tunnel, a narrow passageway that houses not only the median nerve but also the tendons that support the muscles that allow your fingers to move. When this nerve is squeezed, twisted, or pressed for any reason, carpal tunnel syndrome occurs.

Signs and symptoms

In most cases of carpal tunnel syndrome, symptoms have a gradual onset. You may experience the following:

* frequent sensations of burning, tingling, itching, or numbness in your palm and fingers, particularly the thumb, index and middle fingers. Although little or no apparent swelling is observed, you may feel your fingers are swollen and useless.

* Piercing pain radiating to the forearm or even shoulder, and down to the fingers

* A feeling of weakness in your hand affecting your grip strength usually causing you to drop objects

* Loss of sensation in your fingers may occur if your condition is advanced and/or left untreated

Causes

CTS may result from a combination of factors that lead to the compression of or increased pressure on the median nerve and tendons in the carpal tunnel. These causative factors include:

* Underlying medical problems such as diabetes, rheumatoid arthritis, obesity, thyroid disorders, etc.

* Hormonal changes due to menopause, pregnancy, or oral contraceptive pills have also shown to cause narrowing of the carpal tunnel in some cases

* Repetitive and forceful use of the hands and wrists may also cause swelling of the tendons which can lead to the compression of the median nerve

* Injury or trauma to the wrist such as sprain or fracture

Diagnosis

To confirm a carpal tunnel syndrome diagnosis, your doctor will do any or all of the following:

* Physical examination

* Routine laboratory tests and x-rays to rule out any underlying condition

* Ultrasound

* Tine1 test

* Phalen test or wrist-flexion

* Electromyography

Treatment

Carpal tunnel syndrome may be treated with either non-surgical therapy or surgery.

Non-surgical treatment

Drugs – To relieve pain and inflammation, you may take non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen. Corticosteroids (prednisone) may also be prescribed by your doctor to reduce swelling. Lidocaine may also be injected directly into your wrist to alleviate symptoms.

Exercise – This should be done once symptoms have abated, and under the supervision of a physical therapist or an occupational therapist

Alternative therapies – These include acupuncture and chiropractic care although their effectiveness in carpal tunnel syndrome is yet to be proven

Surgery

This is usually recommended for carpal tunnel syndrome patients whose condition persists for over 6 months. There are two types of surgical treatment for this condition namely:

Open release surgery – Performed under local anesthesia, this traditional procedure involves making an incision (up to 2 inches) in the wrist and cutting the carpal ligament to enlarge the carpal tunnel.

Endoscopic surgery – This can either be two-portal or single portal surgery. A two-portal surgery consists of making two 1/2 inch-incisions in your palm and wrist, inserting a camera linked to a tube, observing the tissue on a screen, and cutting the carpal ligament.

Symptom relief is immediate after surgery, but complete recuperation from carpal tunnel syndrome can take months. After effective treatment, carpal tunnel syndrome rarely recurs as most patients attain complete recovery.

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