FAQs on Carpal Tunnel Syndrome (CTS) in Nashville

The carpal tunnel is a tunnel-like, narrow structure in the wrist area. Composing the bottom and sides of the tunnel are the carpal (wrist) bones, and the upper portion is covered with connective tissue, which is called the transverse carpal ligament. Feeling of the palm side of the fingers and thumb is controlled by the medial nerve, which also controls the muscles at the base of the thumb.

In addition, the flexor tendons bend the fingers and thumb, and they also travel through the carpal tunnel. Carpal tunnel syndrome (CTS) is a form of entrapment neuropathy, which causes pain in the wrist, as well as numbness, tingling, and pain of the fingers.

How common is carpal tunnel syndrome?

The prevalence of carpal tunnel syndrome in the general adult population ranges from 3-6%, with a recent U.K. study reporting bilateral carpal tunnel occurring in half of these cases. The incidence of this condition was reported as 3.3 per 1,000 person-years.

What causes carpal tunnel syndrome?

CTS occurs when the tissues (called synovium) around the flexor tendons of the wrist swelling and apply pressure on the median nerve. The synovial tissues lubricate the tendons, allowing the fingers to move. Swelling of the synovium narrows the carpal tunnel, and with time, this crowds the medial nerve.

What are the risk factors for CTS?

Things that contribute to the development of carpal tunnel syndrome are:

  • Excessive use – Hand use over time.
  • Heredity – Carpal tunnels are smaller in some people, which is a trait that runs in families.
  • Female sex – Hormonal changes related to pregnancy and other conditions contribute to the development of CTS.
  • Age – This condition occurs in aging or older people.
  • Certain medical conditions – These include diabetes, thyroid imbalance, and rheumatoid arthritis.

What are the symptoms of carpal tunnel syndrome?

The symptoms of CTS include tingling, numbness, and pain in the hand, wrist, and fingers. In addition, people with this syndrome often experience an electric shock-like feeling of the affected structures, as well as strange sensations that travel up the arm into the shoulder. The symptoms come and go, and are often worse at night, when people curl their wrists with sleep. Many people report a feeling of clumsiness with delicate motions, such as buttoning a shirt.

What tests are used to diagnose CTS?

To determine if or not you have carpal tunnel syndrome, the doctor will review your symptoms, discuss your medical history, and conduct a physical examination. Special tests used to diagnose CTS include x-rays, which check the bones and structures, and electrophysiological testing of the median nerve.

How is CTS treated?

There are several effective treatment options for patients with carpal tunnel syndrome. These include:

  • Bracing or splinting – A brace or splint can be worn at night to keep the wrist in a neutral position. This prevents irritation of the median nerve. Splints are often recommended during the day, which are to be worn during activities that tend to aggravate symptoms.
  • Medications – The most common class of drugs prescribed to treat CTS is nonsteroidal anti-inflammatory drugs (NSAIDs). Mild pain relievers are often used also, such as acetaminophen.
  • Corticosteroid injections – The doctor can inject a corticosteroid medication near the median nerve or directly into the carpal tunnel. This medication decreases inflammation and swelling, which alleviates pressure on the median nerve. In a study involving a three-month follow-up, the success rate of steroid injection for CTS was 77%. Additionally, 63% of study participants reported pain relief at six-month follow-up.

Resources

LeBlanc KE & Cestia W (2011). Carpal tunnel syndrome. Am Family Physician, 83(8):952-958.

Mintalucci DJ & Leinberry CF Jr. (2012).Open versus endoscopic carpal tunnel release. Orthop Clin North Am, 43(4):431-7.

Pomerance J, Zurakowski D, & Fine I (2009). The cost-effectiveness of nonsurgical versus surgical treatment for carpal tunnel syndrome. J Hand Surg Am, 34(7):1193-2000.

Visser, L. H., Q. Ngo, et al. (2011). Long term effect of local corticosteroid injection for carpal tunnel syndrome: A relation with electrodiagnostic severity. Clinical Neurophysiology.