Carpal Tunnel Syndrome (CTS) is one of the most common sources of hand pain and numbness. In the US, as many as 10 million people experience some symptoms of CTS each year, and approximately 500,000 surgeries to treat CTS are performed annually. The symptoms of CTS are variable, but left untreated, the progressive nerve damage that results may lead to permanent hand dysfunction.
Symptoms of CTS usually occur gradually and without a specific injury. Patients may feel pain, numbness, tingling or an electric shock-like feeling mostly in the palm or fingers. Other common symptoms are nighttime symptoms of pain or numbness that wake the patient, clumsiness and a tendency to drop objects, a sense of swelling or tightness in the hand, temperature changes or intolerance in the hand, or hand weakness. Usually these symptoms affect the thumb, index and long fingers, but many patients describe involvement of the entire hand and may even have symptoms radiate up the forearm. Symptoms usually start intermittently with certain activities (driving, riding a bike, holding tools or objects, or at night) but generally become more frequent and may cause permanent changes if untreated. Your orthopaedic hand surgeon may use electrical testing (electrophysiological) of the median nerve function or X-rays in addition to a clinical exam to help confirm diagnosis and clarify the best treatment option for you.
CTS occurs when the synovium tissues surrounding the flexor tendons in the wrist swell and put pressure on the median nerve. The swelling narrows the carpal tunnel and over time, increases pressure on the median nerve. The increased pressure causes nerve swelling, reduces blood flow to the nerve, and prevents adequate oxygen delivery to the nerve. The American Academy of Orthopaedic Surgeons (AAOS) lists five contributing factors to the development of CTS:
- Overuse of the hand;
- Hormonal changes (including pregnancy);
- Preexisting medical conditions including diabetes and rheumatoid arthritis.
Conservative methods of treatment such as bracing or splinting, medication or steroid injections may not be sufficient for many patients with CTS. Patients who have symptoms lasting longer than 10 months, who experience continual numbness, whose muscles in the base of the palm begin to shrink, or who are over the age of 50 are least likely to benefit from conservative methods. Appropriately timed surgery can prevent irreversible damage and improve symptoms and function.
Surgery for CTS reduces pressure on the nerve by incising the ligaments that constrain the carpal tunnel and results in durable improvement in more than 90 percent of patients with established CTS. Traditionally this is accomplished through a one to two-inch incision in the palm. Minimally-invasive endoscopic approaches are possible that accomplish the same thing through half-inch incision at the wrist crease that is cosmetically pleasing.
Compared with other procedures, CTS surgery is very safe. AAOS lists possible complications from surgery including nerve injury, bleeding and infection. Most patients report improved symptoms within days, although continued recovery of sensation and strength may take months as nerve function normalizes. Your physician may recommend hand therapy to assist in strengthening and improving movement.
While there are no proven strategies to prevent CTS, some tips to minimize stress on your hands and wrists include:
- Reduce and relax your grip when performing manual tasks;
- Change hand position often when having symptoms;
- Wear gloves with padded palms when possible;
- Take frequent breaks to give your hands and wrist a break;
- Improve your posture and keep your hands warm to reduce pain and stiffness.
AAOS advises patients to keep in mind that symptoms of CTS generally worsen with time, but symptoms can be modified or stopped in the early stages. If you are experiencing pain in your wrists or hands, be sure to make an appointment with your orthopaedic hand physician as soon as possible.