Carpal Tunnel Syndrome
WHAT IS CARPAL TUNNEL SYNDROME (CTS)
Carpal Tunnel Syndrome can be a chronic painful condition of the wrist area. It is often due to compression of the median nerve in the ligaments of the wrist resulting in the dysfunction of the nerve. The main cause of the condition is thought to be swelling of wrist tendon linings resulting in overcrowding of the carpal tunnel, since the nerve is the most vulnerable structure and is not able to function normally when it is squeezed.
Other conditions associated with CTS include a tumour in the carpal tunnel canal, diabetes mellitus, hypothyroidism, menopause, pregnancy, renal failure, Raynaud's Disease, repetitive strain injuries and Double Crush Syndrome Osterman (Lancet, 1991).
 Figure A: Figure showing the median nerve (dotted lines) deep to the Carpal tunnel ligament.
|
WHAT ARE THE SIGNS AND SYMPTOMS?
Patients usually present with a sensation of "pins and needles" at the fingertips, particularly to the thumb, index, and middle finger. There maybe associated tightness at the wrist area.
In more severe cases, patients may have more pronounced numbness (decreased sensation) and pain. Repetitive activities of the wrist, such as computer typing, driving, reading the newspaper, holding the telephone receiver and using chop sticks can sometimes bring on the sensations. Night symptoms can disturb the patient's sleep. Clumsiness of the hands, such as dropping tea cups, difficulty in buttoning and weakness in pinch and grip activities are seen in severe cases.
DIAGNOSIS
An accurate medical history and clinical examination are usually sufficient for your doctor to make the diagnosis. Your doctor may order X-rays if a bone problem is thought to be a possible cause. Nerve conduction studies, either alone or with electromyography (EMG), may be necessary in severe cases or when a more proximal compression site is suspected.
WHAT ARE THE TREATMENT OPTIONS?
Mild symptoms can be treated with modest lifestyle changes and activity modification, accompanied by oral medication and the application of a wrist splint.
If symptoms persist, you may need surgery.
Your doctor will advise you if your condition suggests a surgical intervention.
Factors to consider:
- Age over 55 years
- Duration over 10 months
- Constant paresthia
- Stenosing flexor tenosynovitis
- Phalen's test positive < 30 seconds
See also Figure B.
Source: Kaplan, Glickel, Eaton (J Hand Surg 1990)
