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Carpal Tunnel Syndrome – Causes, Symptoms & Treatment

Carpal tunnel syndrome is a common nerve compression disorder at the wrist, causing pain, numbness, and tingling in the hand and fingers.

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Things worth knowing about "Carpal Tunnel Syndrome"

Carpal tunnel syndrome is a common nerve compression disorder at the wrist, causing pain, numbness, and tingling in the hand and fingers.

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is one of the most common peripheral nerve compression disorders. It occurs when the median nerve, which runs through a narrow passage at the wrist called the carpal tunnel, becomes compressed. This tunnel also contains nine flexor tendons. When pressure inside the tunnel increases, the median nerve is squeezed, leading to the characteristic symptoms of CTS.

Causes

Carpal tunnel syndrome can develop due to a variety of contributing factors:

Repetitive hand movements: Jobs or activities involving repeated wrist and hand motion (e.g., typing, assembly work)
Hormonal changes: Pregnancy, menopause, or hypothyroidism can cause tissue swelling
Underlying conditions: Diabetes mellitus, rheumatoid arthritis, and gout increase the risk
Anatomical factors: A naturally narrow carpal tunnel or a history of wrist fractures
Inflammation and fluid retention: Swelling of surrounding tissues increases pressure on the nerve

Symptoms

Symptoms typically affect the thumb, index, middle, and part of the ring finger – the area supplied by the median nerve:

Tingling and numbness in the hand, especially at night
Burning or sharp pain that may radiate up the arm
Weakness when gripping objects
A sensation of the hand falling asleep, especially while holding items (e.g., a phone or book)
In advanced cases: muscle wasting at the base of the thumb (thenar atrophy)

Diagnosis

Diagnosis is typically based on a combination of clinical assessment and diagnostic tests:

Medical history and physical examination: Review of symptoms, occupational history, and underlying conditions
Phalen test and Tinel sign: Clinical provocation tests that reproduce typical symptoms
Nerve conduction study (NCS): Measures the speed of electrical signals along the median nerve – the gold standard for confirming CTS and grading its severity
Ultrasound imaging: Visualizes the median nerve within the carpal tunnel

Treatment

Conservative Treatment

For mild to moderate cases, non-surgical approaches are typically tried first:

Wrist splint: Wearing a neutral-position splint at night relieves pressure on the nerve
Corticosteroid injections: Local injections can reduce inflammation and swelling
Physical therapy: Targeted exercises to stretch and mobilize the wrist and hand
Activity modification: Avoiding aggravating movements and making ergonomic adjustments at work

Surgical Treatment

When symptoms persist or are severe, a carpal tunnel release procedure is recommended. The surgery involves cutting the transverse carpal ligament to relieve pressure on the median nerve. The procedure can be performed as an open or endoscopic surgery and generally has excellent outcomes.

Prognosis

With early and appropriate treatment, the prognosis is favorable. Following surgery, tingling and pain typically improve quickly, while full strength recovery may take several weeks to months. In cases of prolonged severe nerve compression, complete recovery may not always be possible.

References

American Academy of Orthopaedic Surgeons (AAOS) – Clinical Practice Guideline on Carpal Tunnel Syndrome (2016): https://www.aaos.org
Keith MW et al. – Diagnosis of Carpal Tunnel Syndrome. Journal of the American Academy of Orthopaedic Surgeons (2009)
World Health Organization (WHO) – Musculoskeletal Conditions: https://www.who.int

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