What is carpal tunnel syndrome?
Carpal Tunnel Syndrome (CTS) is a condition that arises due to compression of the median nerve as it runs down the forearm and into the wrist. This compression typically results in pain, tingling and/or numbness in the palm, thumb, index, and middle finger and can extend into the forearm. CTS is the most common compressive neuropathy with a prevalence of 3-4%1.
What causes carpal tunnel syndrome?
The carpal tunnel is an anatomical compartment located at the base of the palm which contains the median nerve as well as nine tendons of the hand and forearm. The boundaries of the carpal tunnel are formed by the bones of the wrist and the transverse carpal ligament. CTS results when there is a decrease in the size of the compartment, due to factors like overuse, trauma, or arthritis or an increase in the size of its contents due to swelling of the tissue around the flexor tendons, or both3. Since the walls of the carpal tunnel are non-extendable, built-up pressure is unable to escape and results in compression and irritation of the median nerve. This compression results in the hallmark weakness and altered sensation in the parts of the hand supplied by the median nerve.
Common risk factors for CTS include repetitive wrist movements such as typing or machine work, previous wrist injuries, pregnancy, diabetes, and autoimmune disease2.
What are the symptoms of carpal tunnel syndrome?
CTS typically begins gradually with mild tingling or numbness, often at night or with sustained gripping of objects such as a phone or steering wheel. Patients often report feeling relief with stretching or shaking their hands4. As the condition progresses, feelings of tingling and numbness may occur more frequently and patients often complain of burning pain. Symptoms may eventually progress to muscle loss and decreased grip strength; which combined with sensory loss often results in complaints of weakness and often dropping things.
What is the best treatment for carpal tunnel syndrome?
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Individuals with CTS respond well to physiotherapy based treatment. Patients are advised to modify activities to include regular breaks, ensure proper hand ergonomics when typing, and decrease repetitive activities where possible5. Treatment usually involves manual therapy around the hand and wrist as well as exercise to relieve pressure in the wrist and improve blood flow to the irritated nerve. Progress can be monitored using a variety of tools, including handheld dynamometry to measure changes in grip strength.
Should I wear a brace for carpal tunnel syndrome?
Most current recommendations suggest activity modification as initial therapy rather than immobilizing braces. In some cases it is recommended to wear a brace at night or during activities that are known to aggravate symptoms. However, a brace should not generally be used during the day as movement and use of the wrist is required to prevent muscle loss and stiffness7.
Should I get surgery for carpal tunnel syndrome?
For more severe cases with unrelenting pain or in those who have persisting symptoms following conservative management, surgery to release the transverse carpal ligament may be recommended. Surgery was found to be most beneficial in the short term (6 months) to alleviate symptoms, however conservative management resulted in similar symptom relief in the long term (12-18 months).
- CTS is common affecting up to 4% of people.
- Mild to moderate cases of CTS can be conservatively managed with a range of treatment methods and exercises.
- Individuals with constant pain or no improvement after a period of conservative management may be candidates for surgical management.
- Chesterton, L. S., Blagojevic-Bucknall, M., Burton, C., Dziedzic, K. S., Davenport, G., Jowett, S. M., . . . Roddy, E. (2018). The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): An open-label, parallel group, randomised controlled trial. The Lancet (British Edition), 392(10156), 1423-1433. doi:10.1016/s0140-6736(18)31572-1
- Bobowik, P. Ż. (2019). Effectiveness of physiotherapy in carpal tunnel syndrome (CTS). Postępy Rehabilitacji, 2019(2), 47-58. doi:10.5114/areh.2019.85023
- RH Gelberman; PT Hergenroeder; AR Hargens; GN Lundborg; WH Akeson (1 March 1981). “The carpal tunnel syndrome. A study of carpal canal pressures”. The Journal of Bone and Joint Surgery. 63 (3): 380–383. doi:10.2106/00004623-198163030-00009. PMID 7204435.
- Ashworth NL, MBChB. Carpal Tunnel Syndrome Clinical Presentation. 1994 [Updated 2014 Aug 25; cited 2015 March 20].fckLRAvailable from:fckLRhttp://emedicine.medscape.com/article/327330-clinical.
- Carpal Tunnel Syndrome Justin O. Sevy; Matthew Varacallo. Last Update: December 21, 2019.
- D’Angelo, Kevin; Sutton, Deborah; Côté, Pierre; Dion, Sarah; Wong, Jessica J.; Yu, Hainan; Randhawa, Kristi; Southerst, Danielle; Varatharajan, Sharanya (2015). “The Effectiveness of Passive Physical Modalities for the Management of Soft Tissue Injuries and Neuropathies of the Wrist and Hand: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration”. Journal of Manipulative and Physiological Therapeutics. 38 (7): 493–506. doi:10.1016/j.jmpt.2015.06.006. PMID 26303967.