Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome (CTS)?
CTS is a common nerve disorder involving the wrist that can cause pain, tingling, numbness and weakness in your fingers and thumb.  The carpal tunnel
is located in the wrist on the palm side of the hand just beneath the skin surface (palmar surface).  Several tendons (tissues that connect muscles to
bone) and the median nerve pass through a bony canal called the carpal tunnel.  When this median nerve is squeezed by swollen tissues, it slows or
blocks nerve impulses from traveling through the nerve.  This pressure causes the numbness, tingling, and weakness of the hand.   As a result, CTS may
interfere with hand strength and sensation, and cause a decrease in hand function. Usually CTS affects only one hand but can affect both hands at the
same time.   (see below)

What Causes CTS?
In most cases, the cause of CTS is unknown.
Anything that reduces the space for the median nerve in the carpal tunnel can cause CTS.  Other causes may include:
*Injuries that damage the wrist
*Arthritis conditions, i.e. rheumatoid arthritis, which can cause swelling of tissues in the carpal tunnel, resulting in pressure on the median nerve.
*Work conditions and hobbies that require repetitive wrist or finger motions

What are the Symptoms of CTS?
The main symptom of CTS is numbness of the fingers.  If you have CTS, you may experience any of these symptoms:
*Pain, tingling and numbness of your thumb, index, middle and/or ring finger
*Pain that shoots from your hand up your forearm, and in some cases, as far as your shoulder
*A swollen feeling in your fingers, even though they may not be visibly swollen

You may also notice the following:
*Your hands feel stiff in the morning
*Your symptoms worsen at night
*You have trouble grasping or pinching objects
*You drop objects more than usual
*You have trouble using your hands for certain tasks such as holding a book, driving.

Who Gets CTS?
CTS affects 3% to 7% of the population.  Middle aged to older individuals are more likely to develop CTS than younger persons, and females three times
more frequently than males.  

How is CTS Diagnosed?
Diagnosis of CTS is often made by the physician by reviewing your medical history, a physical examination of your hand and wrist, and an accurate
description of your symptoms.  In the Phalen Test, the wrist is bent to 90 degrees for one minute that may cause symptoms to appear in the hand.  In
another test, tapping the wrist with a reflex hammer may cause an electric shock-like sensation (Tinnel’s Sign).  Furthermore, blood tests and X-rays of
the hands may be used to find out if any other medical problems are causing CTS. However, it is the use of the Nerve Conduction Test that confirms CTS
and its severity. This measures the nerve’s ability to send electrical impulses across the carpal tunnel from the arm to the hand.  If the electrical impulses
are slowed down in the carpal tunnel, then you probably have CTS.  In recent years, diagnostic ultrasonography and MRI scans have been used to
diagnose CTS and exclude other causes of hand and wrist symptoms.

How is CTS Treated?
The goal of treatment is to relieve pain and to prevent CTS from getting worse.  The type of treatment prescribed depends on the severity of your CTS.  
Therefore, treatment may include one or all of the following:
1.        Work Changes involve adjusting your daily work activities to help prevent and/or relieve CTS symptoms, i.e. rest your wrists and hands often,
alternate tasks to reduce the pressure on your wrist.
2.        Medication such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDS) can be used to relieve the symptoms.
3.        Splinting the wrist helps keep the wrist straight during the night, and thus decreases   the pressure on the median nerve.
4.        Cortisone injection into the carpal tunnel often can reduce the swelling that cause pressure on the median nerve for weeks to months and can be
5.        When the above measures fail to relieve symptoms, surgical opening of the carpal tunnel (called “carpal tunnel release”) or an endoscopic
procedure to relieve the pressure on the median nerve is appropriate.
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