Carpal Tunnel Syndrome

Carpal tunnel syndrome(CTS) is a condition affecting the wrist and hand. It is characterised by numbness and tingling in the forearm and hand, particularly the thumb, index and middle fingers. It may occur in one hand or bilaterally. As the injury progresses, weakness and lack of dexter

ity and sensation in the hand may also occur.

The carpal tunnel is an anatomical structure below the palm. It is made of the carpal bones on the bottom and sides, and the transverse carpal ligament on the top. The carpal tunnel contains tendons of wrist and finger flexor muscles. These are the muscles that bring your hands into a fist and bring the palm of your hand towards your elbow. 

The carpal tunnel also contains the median nerve. This nerve helps you move your forearm, wrist, thumb, index and middle fingers. It also provides sensation to these areas.

If the transverse carpal ligament or flexor retinaculum become tight surrounding the median nerve, compression or entrapment occurs. This leads to excessive pressure on the median nerve and is the cause of the symptoms of CTS.

Factors that contribute to the incidence of CTS include

Repetitive use - high volume use of the hands and wrist, particularly flexion type of movement may lead to swelling of the tendons as they pass through the carpal tunnel.

Hand and Wrist position - as mentioned above excessive amounts of wrist and hand flexion can lead to swelling of the tendons in the carpal tunnel. This is also common with sleeping position, hands that remain curled in ball at night can exacerbate CTS.

Pregnancy - Hormonal changes during pregnancy and post-partum can lead to swelling that adds pressure to the median nerve.

Heredity - People of smaller stature may have a smaller carpal tunnel leading to an increased risk.

To test for CTS, your doctor may do a variety of tests. They may bend and hold your wrist in flexion to check for numbness or tingling. Testing for weakness and muscle atrophy may also be done. Imaging may also be done to evaluate the median nerve and to rule out other conditions that have similar symptoms.

CTS has a variety of treatments depending on the severity.

Bracing - Wearing a brace or night splint can help to prevent flexion of the wrist. This treatment is helpful in alleviating symptoms for all stages of CTS and may be done in conjunction with other treatments.

Activity changes - If your work or hobbies require excessive amount of wrist flexion, ergonomic changes can be made to help slow or stop the progression of CTS.

Exercises -  Exercises and stretching may be to alleviate tightness throughout the flexors of the wrist and hand.

Surgery - For later stages of CTS, a surgical release of the transverse carpal ligament may be performed to increase the size of the carpal tunnel.