Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a common condition that causes pain, numbness, tingling and weakness in the hand and up the arm. The carpal tunnel is a narrow passageway in the wrist. The wrist or carpal bones form the floor and walls of the tunnel, with a strong ligament forming the roof. Inside the tunnel, the tendons to the thumb and fingers surround the Median nerve, which is responsible for sensation and some motor function in the hand.

When the tunnel becomes narrowed or when tissues surrounding the flexor tendons swell, putting pressure on the median nerve it causes pain and sensory abnormalities. This is known as carpal tunnel syndrome. Often this is made worse with the wrist bent and often leads to increased symptoms during sleep or specific activities.

What are the causes of carpal tunnel syndrome?

Carpal tunnel syndrome is commonly associated with many chronic illnesses such as diabetes, rheumatoid arthritis and thyroid gland imbalances and can occur simultaneously with other conditions in the hand. Risk factors include genetics, repetitive hand use, and doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time. In most cases, carpal tunnel syndrome is caused by a combination of these factors.

How is carpal tunnel syndrome treated?

Without treatment, carpal tunnel syndrome will most likely progress over time. Treatment is firstly aimed at controlling any underlying diseases and preventing unnecessary pressure on the nerve. Splints, braces, medication and hand therapy are used and may be effective in treating early and uncomplicated CTS. Steroid injections into the carpal tunnel may relieve symptoms temporarily.

For more severe cases where non-surgical methods have failed, surgery may be considered. The decision of whether to have surgery is based on the severity of your symptoms. The goal for this hand surgery is to increase the size of the tunnel to relieve the pressure on the nerves. This is done by releasing or cutting through the roof or ligament of the tunnel. Using local anaesthesia or general anaesthesia, this surgery is routinely done through a 2-3cm incision in the palm of the hand, but can also be done through an endoscopic procedure, which is minimally invasive. Which of the two would be best will be decided by your hand surgeon on an individual basis.