What is carpal tunnel syndrome?
In carpal tunnel syndrome (CTS) a nerve in the tunnel of the wrist becomes trapped. This causes tingling, pain and numbness in the hand and the fingers.
The carpal tunnel is a passageway on the inner side of the wrist through which a nerve must pass on its way to the hand. The tunnel consists of the carpal bones on the underside with a roof consisting of a tough sheet of ligament covering the nerve. The nerve can become trapped if this ligament becomes swollen or inflamed, or if the shape of the tunnel changes due to arthritis or a broken wrist, for example. The symptoms can develop in diabetes, pregnancy and thyroid disease and as a result of accidents, but in most cases no cause is found.
Signs and symptoms
The symptoms in CTS are usually felt at night and consist of a tingling feeling or numbness in the hand, the thumb, the index finger and the middle finger and sometimes also the ring finger. There may also be pain in the hand, wrist and lower arm, a sensation that the hand is swollen or even loss of strength in the hand. The symptoms can keep you awake at night. Waving the hand back and forth can relieve the symptoms. CTS is usually seen on one side and is more common in women. Symptoms of carpal tunnel syndrome may still continue after surgery for this condition. In that case the nerve has become damaged; this causes the nerve to pass on electrical impulses to the spinal cord and the brain which is why pain is felt.
How is carpal tunnel syndrome diagnosed?
In general a diagnosis of CTS is made according to the classical
pattern of symptoms described by the patient.
A neurological examination of the hand can establish the presence of muscle paralysis in the ball of the thumb and numbness in the ends of the fingers.
Do I need additional examinations?
- EMG of the nerve in the carpal tunnel (the median nerve)
What are my treatment possibilities?
Initially there will be awaited. The advice is to avoid the movements that cause the symptoms as much as possible. A splint may also help, if only for the night, to ensure the wrist stays straight and the nerve does not become pinched.
Interventional Pain Treatments
- Local infiltration in carpal tunnel
- PRF treatment of the median nerve