Introduction
Carpal tunnel syndrome (CTS) is a painful condition in the hand and occurs when the median nerve becomes compressed in an area of the wrist, known as the carpal tunnel.
The carpal tunnel is a passageway between the wrist and the hand is about an inch wide.
The median nerve provides feeling to the thumb and all fingers except the pinky finger. It also provides nerve signals to control the muscles at the base of the thumb.
What Actually Happens?
As the fingers or the wrist moves, the tendons of the fingers slide and glide through the carpal tunnel which is usually well lubricated.
When repetitive and prolonged movements cause the lubricating system to malfunction, inflammation and swelling occur around the tendons. The median nerve in the carpal tunnel area may then become compressed.
Repeated inflammation causes the formation of thick scar tissue, which could crowd the carpal tunnel, and further restrict smooth movement.
Symptoms
- Tingling / numbness
- An electric-like shock sensation through the wrist, hand, fingers
- Pain
- Weakness in the thumb and fingers. (tendency to drop things)
- Dry skin (may develop)
Who Gets CTS?
CTS may affect one or both hands and in most cases, the dominant hand is first to be affected.
CTS is known to be associated with activities that involve:
- Repetitive wrist/hand movements
- Prolonged bent or awkward wrist positions
- Strong gripping
- Usage of vibrating hand tools
Other contributing factors are:
- Women – who are concomitant to hormonal changes (e.g. pregnancy, menopause) and have a smaller carpal tunnel structure
- Underlying health conditions (diabetes, gout, thyroid gland imbalance, rheumatoid arthritis)
- Previous wrist trauma (e.g. sprain, fracture, dislocation)
CTS is usually a result of a combination of factors contributing to the development of the condition, rather than a single nerve issue.
What Happens if You Ignore CTS?
Initially, the symptoms feel manageable since they come and go. However, the condition can worsen gradually. The symptoms may occur more frequently and may even travel up to the forearm and shoulder.
If left untreated, the irritated median nerve will be malfunction. This leads to:
- Loss of sensation (unable to differentiate between hot and cold by touch)
- Muscle wasting (shrinking) in the thumb muscles, leading to less strength and coordination in the thumb and fingers
Conservative Treatment
- Avoid / reduce / modify painful activities
- Splint/brace to rest and immobilize the wrist (usually 24 hours for 4-6 weeks)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control and inflammation
- Corticosteroids injection
- Physiotherapy for active pain relief and recovery, strengthening and return to daily activities
Physiotherapy and Rehabilitation
Recovery Goals
- Pain reduction and inflammation control using modalities and massage
- Improve nerve mobility and restore function with rehabilitative exercises
- Lifestyle modification and advice on the wrist positioning to minimize the risk of median nerve re-irritation and return of symptoms
Surgical Intervention
If the above conservative measures are not effective after one to two months, the doctor may perform diagnostic tests such as a nerve conduction test and electromyograms to determine if surgery is an effective treatment option.
