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CTS – Carpal Tunnel Syndrome: Causes and Treatment

CTS (Carpal Tunnel Syndrome) is a common nerve compression disorder at the wrist causing numbness, tingling, and pain in the hand and fingers.

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CTS (Carpal Tunnel Syndrome) is a common nerve compression disorder at the wrist causing numbness, tingling, and pain in the hand and fingers.

What is Carpal Tunnel Syndrome (CTS)?

Carpal Tunnel Syndrome (CTS) is one of the most common peripheral nerve disorders. It occurs when the median nerve becomes compressed as it passes through the carpal tunnel – a narrow passageway on the inner side of the wrist formed by carpal bones and a tough fibrous band called the flexor retinaculum. Increased pressure on the nerve leads to the hallmark symptoms of CTS: numbness, tingling, and pain primarily in the thumb, index finger, middle finger, and the thumb-side half of the ring finger.

Causes

CTS can result from various factors that either increase pressure within the carpal tunnel or cause swelling of the surrounding tissues:

Repetitive hand movements: Jobs involving repeated hand and wrist motions (e.g., typing, assembly line work)
Pregnancy: Hormonal changes lead to fluid retention, increasing tunnel pressure
Medical conditions: Diabetes mellitus, hypothyroidism, rheumatoid arthritis, gout
Anatomical factors: Wrist fractures, cysts, or tumors within the carpal tunnel
Obesity: Higher body weight is considered a risk factor
Genetic predisposition: A familial tendency has been observed

Symptoms

Symptoms of CTS typically affect the fingers supplied by the median nerve – the thumb, index, middle, and part of the ring finger. Common symptoms include:

Numbness and tingling (paresthesia), especially at night or early morning
Burning or shooting pain in the wrist that may radiate up the arm
Weakness and reduced grip strength
Difficulty holding small objects
In advanced cases: muscle wasting (atrophy) of the thenar eminence (thumb base)

Diagnosis

CTS is typically diagnosed through a combination of clinical examination and diagnostic tests:

Medical history and physical examination: Assessment using provocation tests such as the Phalen test (wrist flexion for 60 seconds) or the Tinel sign (tapping over the carpal tunnel)
Nerve conduction study (NCS): Measures the speed of electrical signals through the median nerve – considered the gold standard for CTS diagnosis
Electromyography (EMG): Evaluates muscle activity when advanced nerve damage is suspected
Ultrasound or MRI: Used to rule out structural causes such as cysts or tumors

Treatment

Conservative Treatment

For mild to moderate CTS, non-surgical approaches are usually tried first:

Wrist splinting: Wearing a splint at night to keep the wrist in a neutral position reduces pressure on the nerve
Corticosteroid injections: Local injections of anti-inflammatory medication can provide significant symptom relief
Physical therapy: Stretching and strengthening exercises to reduce nerve compression
Treatment of underlying conditions: Managing diabetes, thyroid disorders, or other contributing diseases

Surgical Treatment

When CTS is severe or does not respond to conservative treatment, surgery may be recommended. The procedure, known as carpal tunnel release (performed open or endoscopically), involves cutting the flexor retinaculum to relieve pressure on the median nerve permanently. It is a brief outpatient procedure with a high success rate and good long-term outcomes for most patients.

References

Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. 2008;77(1):6-17.
American Academy of Orthopaedic Surgeons (AAOS): Clinical Practice Guideline on Carpal Tunnel Syndrome, 2016. Available at: www.aaos.org
World Health Organization (WHO): International Classification of Diseases (ICD-11), Entry G56.0 – Carpal Tunnel Syndrome.

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