Carpal Tunnel Syndrome (CTS)

he Median Nerve runs from the arm through the wrist and into the fingers, passing through a narrow channel known as the Carpal Tunnel at the center of the wrist. The wrist bones form the base of this tunnel, while the Transverse Carpal Ligament covers the top. Ligaments, which are robust bands of tissue, connect the bones. Besides the Median Nerve, the Carpal Tunnel houses numerous tendons that connect to the muscles responsible for bending or flexing the fingers.

The Median Nerve provides sensation to the thumb, index finger, middle finger, and half of the ring finger, while also sending signals to the Thenar Muscles that facilitate thumb movement. When the Median Nerve is compressed within the Carpal Tunnel, it transmits incorrect signals as it reaches the hand and fingers.

Carpal Tunnel Syndrome arises when tissues and tendons within the Carpal Tunnel swell, narrowing the available space. This swelling may be linked to various medical conditions, including hypothyroidism and diabetes. Increased pressure within the tunnel compresses the Median Nerve, disrupting its functionality and leading to the syndrome's symptoms. Often, the precise cause of Carpal Tunnel Syndrome remains unidentified.

Factors such as rheumatoid arthritis, joint dislocations, and fractures can narrow the tunnel. Hormonal changes that lead to fluid retention may also trigger the condition in some women, particularly during pregnancy, premenstrual syndrome, or menopause.

The hallmark symptoms of Carpal Tunnel Syndrome include pain, numbness, and tingling. These sensations typically occur in the thumb, index finger, middle finger, and half of the ring finger. Some individuals describe the pain as a deep ache or burning sensation, which may radiate up into the arms. The thumb may feel weak and clumsy, making it difficult to grasp objects, often resulting in dropped items. Symptoms may intensify at night, during specific activities, or in cold conditions.

To diagnose Carpal Tunnel Syndrome, your doctor will conduct a physical examination, review your medical history, and inquire about your activities and symptoms. The examination will involve checking the wrist and hand for sensation and performing a comprehensive hand assessment.

Your doctor might perform several simple tests to ascertain if there is pressure on the Median Nerve. For the Phalen’s Test, you'll be asked to flex your wrist firmly for 60 seconds; a positive result is indicated by numbness, tingling, or weakness. During the Tinel’s Sign test, your doctor will tap the Median Nerve at the wrist, with a positive result showing tingling or numbness along the nerve's path. If your doctor suspects an underlying medical condition contributing to your symptoms, lab tests may be ordered, and X-rays may be taken to check for arthritis or fractures.

In some situations, physicians employ nerve conduction studies to evaluate the Median Nerve's function and locate the compression site. A commonly used test is the Nerve Conduction Velocity (NCV) test, which measures the time taken for a nerve signal to travel between two points. Electrodes will be placed on your skin over the Median Nerve, and while the NCV test may be uncomfortable, this discomfort is temporary.

An Electromyography (EMG) test often accompanies the NCV test. This test assesses the electrical impulses in the muscles to identify poor nerve input. Healthy muscles require electrical impulses for movement. Fine needles are inserted into the muscles controlled by the Median Nerve to measure the impulses when the muscles contract. The EMG may cause some discomfort, and your muscles may feel sore afterward.

Often, the symptoms of Carpal Tunnel Syndrome can be alleviated without the need for surgery. Certain underlying medical conditions related to the syndrome can be treated, and some cases respond positively to pain relief and rest measures. Your doctor might recommend wearing a splint at night to keep your wrist in a neutral position.

Splints may also be used during activities that exacerbate your symptoms, providing proper wrist alignment and support. Over-the-counter anti-inflammatory medications may be suggested to alleviate pain and swelling. In some cases, doctors may opt for corticosteroid injections to relieve symptoms.

Surgery is advised when non-surgical approaches are ineffective or if the condition worsens. Several outpatient surgical options exist to relieve pressure on the Median Nerve, and your doctor will guide you in selecting the most suitable procedure.

The standard surgical approach for Carpal Tunnel Syndrome is known as Open Release. In this procedure, the surgeon uses a local or regional anesthetic to numb the hand area. A 2 to 3-inch incision is made along the palm to access the Transverse Carpal Ligament, the Carpal Tunnel's roof. The ligament is then cut to enlarge the tunnel, alleviating pressure on the Median Nerve. This surgery typically lasts about fifteen minutes.

Another option is the Endoscopic Carpal Tunnel Release, performed using an endoscope inserted through a small incision. An endoscope is a small device with a light and lens that allows the surgeon to view the Carpal Tunnel while minimizing disruption to surrounding tissues. This procedure often employs a local or regional anesthetic to numb the wrist and hand, although some patients may be sedated.

The surgeon makes a small incision below the wrist crease and uses the endoscope to visualize the Carpal Tunnel. In some cases, a second incision in the palm may be necessary. Guided by the endoscope, the surgeon places a tube called a cannula next to the Median Nerve, through which a special instrument is inserted to cut the Transverse Carpal Ligament. This procedure also enlarges the Carpal Tunnel to relieve pressure on the Median Nerve. Since Endoscopic Carpal Tunnel Release preserves more tissue in the palm, patients often experience faster healing and less discomfort.

After surgery, your incision will be covered with a soft dressing. Your physician may recommend wearing a splint for support and to promote healing. You can start moving your fingers right away, but heavy gripping or pinching should be avoided for approximately six weeks. Your doctor may suggest occupational or physical therapy to regain strength, joint stability, and coordination. Full recovery may take several months as wrist and hand strength returns to normal.

Recovery from Carpal Tunnel Surgery is tailored to the individual, depending on the severity of the condition and the surgical method used. Your doctor will provide information on what to expect during your recovery.