Carpal Tunnel Syndrome: Causes, Symptoms, Diagnosis, and Treatment Options

Table of Contents

What is Carpal Tunnel Syndrome?
Causes
Carpal Tunnel Syndrome Symptoms
Diagnosis and Tests
Carpal Tunnel Syndrome Treatment

Non-surgical treatments
Surgical treatments

Complications
Prevention

Update: October 25, 2023

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome, or CTS, is a medical condition characterized by the compression of the median nerve as it passes through the carpal tunnel, a narrow passageway in the wrist. This compression causes a range of symptoms, often including wrist pain, tingling, numbness, and weakness in the hand and fingers. It typically affects the thumb, index finger, middle finger, and half of the ring finger, with the little finger typically being unaffected

The carpal tunnel is a small, narrow space located on the palm side of the wrist. To be more specific, it is formed by the carpal bones on the backside and the transverse carpal ligament on the front. The carpal bones are a group of eight small, irregularly shaped bones that make up the wrist joint. The transverse carpal ligament acts as a protective roof for the tunnel. Within this confined space, nine tendons, along with the median nerve, pass through.

When pressure or swelling occurs within the carpal tunnel, it can compress the median nerve, leading to the characteristic symptoms of Carpal Tunnel Syndrome. This compression can result from various factors, including repetitive hand movements, wrist injuries, or underlying medical conditions.

Causes

There are many possible causes and risk factors for CTS. Some of carpal tunnel syndrome causes and risk factors are:

Heredity. Some people have a smaller carpal tunnel or a different shape of the wrist bones, which can make them more prone to nerve compression.
Repetitive hand use. Activities that involve repeated or prolonged bending, flexing, or gripping of the wrist can increase the pressure on the nerve and cause inflammation of the tendons.
Hand and wrist position. Holding the wrist in an extreme or awkward position for a long time can also affect the nerve.
Pregnancy. Hormonal changes and fluid retention can cause swelling in the wrist and reduce the space in the carpal tunnel.
Health conditions. Certain diseases, such as diabetes, rheumatoid arthritis, thyroid disorders, and gout, can affect the nerves or cause inflammation in the wrist.
Injury. A fracture, dislocation, or sprain of the wrist can damage the nerve or narrow the carpal tunnel.
Age. Carpal tunnel syndrome is more common in older adults, especially women.

Carpal Tunnel Syndrome Symptoms

Carpal tunnel syndrome symptoms usually start gradually and may come and go at first. However, as the condition worsens, the symptoms may become more frequent and persistent. Some of the common symptoms of carpal tunnel syndrome are:

Numbness, tingling, or burning sensation in the thumb, index, middle, and part of the ring finger. These are the fingers that are supplied by the median nerve. The little finger is usually not affected.
Pain or discomfort in the hand, wrist, or forearm. The pain may radiate up to the elbow or shoulder. The pain may be worse at night or when using the hand for certain activities.
Weakness or clumsiness in the hand. This may make it difficult to perform tasks that require fine movements, such as buttoning clothes, writing, or typing. Some people may drop objects or have trouble holding them.
Muscle wasting or atrophy in the base of the thumb. This may occur in severe or long-standing cases of carpal tunnel syndrome. The muscles that control the thumb may become smaller and weaker due to nerve damage.

The symptoms of carpal tunnel syndrome can vary from person to person and may depend on the cause and severity of the condition. Some people may have mild symptoms that do not interfere with their daily activities, while others may have severe symptoms that affect their quality of life. If left untreated, carpal tunnel syndrome can lead to permanent nerve damage and loss of function in the hand.

Diagnosis and Tests

To diagnose carpal tunnel syndrome, a doctor will ask about your symptoms, medical history, and possible risk factors. The doctor will also perform a physical examination and some tests to confirm the diagnosis and rule out other conditions.

The physical examination for carpal tunnel syndrome may include:

Checking your hand and wrist for signs of swelling, bruising, tenderness, or deformity
Testing your sensation, strength, and reflexes in your fingers and thumb
Performing some special tests to provoke your symptoms, such as tapping on the median nerve (Tinel's sign) or bending your wrist (Phalen's test)

Tests to diagnose carpal tunnel syndrome may include:

X-rays. These can show if there is any fracture, arthritis, or abnormality of the wrist bones.
Ultrasound. This can show if there is any swelling or compression of the median nerve.
Nerve conduction studies. These can measure how fast and how well the nerve sends signals along its path.
Electromyography. This can measure how well the muscles controlled by the nerve work.

These tests can help the doctor determine the severity and cause of your carpal tunnel syndrome and plan the best treatment for you. The treatment may include medication, splinting, exercises, injections, or surgery, depending on your condition.

Carpal Tunnel Syndrome Treatment

Carpal tunnel syndrome treatment depends on the severity of the symptoms and the underlying cause of the condition. There are various treatment approaches, including both non-surgical and surgical options.

Non-surgical treatments

Non-surgical treatments are usually recommended for mild to moderate cases of carpal tunnel syndrome, or when the symptoms are intermittent or temporary. Some of the non-surgical treatments are:

Splinting or bracing. Wearing a device that keeps the wrist in a neutral position (carpal tunnel wrist braces) can help relieve pressure on the nerve and reduce symptoms, especially at night. Сarpal tunnel wrist brace with metal splint from Zofore Sport can be bought online from our store.

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Medications. Anti-inflammatory drugs, such as ibuprofen or naproxen, can help ease pain and inflammation in the short term. Corticosteroids, such as prednisone or cortisone injections, can also help reduce swelling and relieve symptoms temporarily. However, these medications do not cure carpal tunnel syndrome and may have side effects.
Activity changes. Avoiding or modifying activities that worsen the symptoms can help prevent further damage to the nerve. Taking frequent breaks, stretching exercises, improving posture and ergonomics, and using tools that fit well and do not strain the wrist are some examples.

Surgical treatments

Surgical treatments are usually considered for severe cases of carpal tunnel syndrome, or when non-surgical treatments have not worked or have stopped working. Surgery aims to release the pressure on the median nerve by cutting the ligament that forms the roof of the carpal tunnel (transverse carpal ligament). This increases the space in the carpal tunnel and improves blood flow and function of the nerve. There are two main types of surgery for carpal tunnel syndrome:

Open carpal tunnel release. This is a traditional surgical technique that involves making a small incision in the palm of the hand and cutting the transverse carpal ligament. The procedure is usually done under local anesthesia and does not require an overnight stay in the hospital. The recovery time may vary from a few weeks to a few months.
Endoscopic carpal tunnel release. This is a minimally invasive surgical technique that involves making one or two smaller incisions in the wrist and using a miniature camera (endoscope) to see inside the carpal tunnel and cut the transverse carpal ligament. The procedure is also done under local anesthesia and does not require an overnight stay in the hospital. The recovery time may be shorter than open surgery.

Both types of surgery have similar outcomes and risks. The risks include bleeding, infection, wound healing problems, nerve injury, scar formation, and recurrence of symptoms. The choice of surgery depends on several factors, such as your preference, your doctor's experience, and your insurance coverage.

Carpal tunnel syndrome is a common condition that can affect anyone who uses their hands frequently or has certain risk factors. It can cause discomfort and disability if left untreated. However, with proper diagnosis and treatment, most people with carpal tunnel syndrome can recover their hand function and quality of life.

Complications

However, if carpal tunnel syndrome is left untreated, it can lead to serious complications that may affect the function and quality of life of the patient. Possible complications of untreated carpal tunnel syndrome are:

Permanent nerve damage. If the pressure on the median nerve is not relieved, it can cause irreversible damage to the nerve fibers and affect the sensation and movement of the hand and fingers. This can result in loss of feeling, coordination, and strength in the affected hand.
Muscle wasting or atrophy. The median nerve also controls some small muscles at the base of the thumb. If the nerve is damaged, these muscles may become smaller and weaker over time. This can cause difficulty in performing tasks that require fine movements, such as pinching, grasping, or writing.
Infection. In rare cases, untreated carpal tunnel syndrome can lead to infection in the wrist or hand. This can happen if the skin over the carpal tunnel becomes ulcerated or broken due to severe swelling or inflammation. Infection can spread to the bones, tendons, or nerves and cause further damage and complications.
Disability and reduced quality of life. Untreated carpal tunnel syndrome can affect the daily activities and work performance of the patient. The pain, numbness, weakness, and stiffness in the hand and wrist can limit the ability to perform tasks that require manual dexterity, such as typing, driving, cooking, or playing an instrument. This can lead to reduced productivity, income loss, or job loss. Moreover, untreated carpal tunnel syndrome can affect the emotional and psychological well-being of the patient. The chronic pain and disability can cause stress, anxiety, depression, or low self-esteem.

Therefore, it is important to seek medical attention as soon as possible if you have any symptoms of carpal tunnel syndrome. Early diagnosis and treatment can help prevent further damage to the nerve and improve your recovery. Your doctor will recommend the best treatment option for you based on your condition and preferences.

Prevention

Although there is no sure way to prevent carpal tunnel syndrome, you can take some steps to reduce the stress on your hands and wrists and lower your risk of developing or worsening the condition. List of carpal tunnel syndrome prevention tips:

Reduce your force and relax your grip. When you use a keyboard, a mouse, a pen, or other tools, try to apply less pressure and use a softer touch. You can also use devices that are more comfortable and ergonomic for your hand, such as a pen with a large, soft grip or a mouse with a wrist rest.
Take short, frequent breaks. Every 10 to 15 minutes, stop what you are doing and stretch and bend your hands and wrists gently. You can also alternate tasks that use different muscles or motions. This can help prevent fatigue and inflammation of the tendons in the carpal tunnel.
Watch your form. Keep your wrist in a neutral or straight position as much as possible. Avoid bending your wrist too far up or down, or holding it at an awkward angle. Adjust your keyboard, chair, desk, or monitor so that they are at a comfortable height and distance for you.
Improve your posture. Poor posture can affect the alignment of your neck, shoulders, arms, and wrists. This can put pressure on the nerves and muscles in these areas and cause pain or numbness in your hand. Try to sit up straight, relax your shoulders, and keep your elbows close to your body.
Keep your hands warm. Cold temperatures can make your hand muscles stiff and tight, which can increase the pressure on the median nerve. If you work in a cold environment, wear gloves or mittens to keep your hands warm and flexible.
Manage your health conditions. Some health problems, such as diabetes, arthritis, thyroid disorders, and gout, can increase your risk of developing carpal tunnel syndrome. If you have any of these conditions, follow your doctor's advice on how to control them and prevent complications.

By following these prevention tips, you can help protect your hands and wrists from carpal tunnel syndrome. However, if you experience any symptoms of carpal tunnel syndrome, such as numbness, tingling, pain, or weakness in your hand or wrist, you should see a doctor for diagnosis and treatment as soon as possible. Early treatment can help prevent permanent nerve damage and improve your recovery.

Carpal Tunnel Syndrome is a prevalent condition that can cause significant discomfort. Understanding its causes, symptoms, and treatment options is crucial to managing and preventing this condition.

References

NHS “Carpal tunnel syndrome”
National Institute of Neurological Disorders and Stroke (NIH) “Carpal Tunnel Syndrome”
American Academy of Orthopaedic Surgeons (AAOS) “Carpal Tunnel Syndrome”
WebMD “Carpal Tunnel Syndrome”
American Society for Surgery of the Hand (ASSH) “Carpal Tunnel Syndrome”

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