Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a condition that affects the hand and wrist, leading to pain, numbness, and tingling. It occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist.

The carpal tunnel—a narrow, rigid passageway of ligament and bones at the base of the hand—houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm.

The causes of Carpal Tunnel Syndrome involve a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel rather than a direct problem with the nerve itself. These factors include:

• Anatomical Factors
  A wrist fracture or dislocation that alters the space within the carpal tunnel, which can irritate the median nerve. The presence of a smaller carpal tunnel in some people may make them more susceptible to CTS.
• Gender
  Women are more likely than men to develop CTS, partly due to hormonal factors and the generally smaller size of the carpal tunnel in women, which can lead to increased pressure on the median nerve.
• Inflammatory Conditions
  Conditions that cause inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in the carpal tunnel, putting pressure on the median nerve.
• Illnesses
  Certain illnesses, including diabetes, metabolic disorders, and thyroid disorders, can increase the risk of nerve damage, including damage to the median nerve.
• Obesity
  Being overweight is a significant risk factor for developing CTS. Maintaining a healthy weight can reduce the risk.
• Fluid Retention
  Fluid retention may increase the pressure within the carpal tunnel, irritating the median nerve. This is often seen during pregnancy and menopause.
• Workplace Factors
  Working with vibrating tools or on an assembly line that requires prolonged or repetitive wrist flexing can create harmful pressure on the median nerve or worsen existing nerve damage.

Symptoms of Carpal Tunnel Syndrome typically start gradually and can affect one or both hands. If untreated, symptoms can progress and become severe. Key symptoms include:

• Numbness, Tingling, and Pain
  These are primarily in the thumb, index, middle, and ring fingers. The sensation may be similar to the feeling of the hand “falling asleep” and may extend up the arm.
• Weakness
  Individuals may experience weakness in their hands and a tendency to drop objects. This may be due to the numbness in the hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.
• Nighttime Symptoms
  Many people report that their symptoms are worse at night. This may be due to the relaxed position of the hand while sleeping, which can exacerbate symptoms.
• Symptom Triggering Movements
  Activities like driving, using a phone, reading, or holding a book may trigger symptoms.
• Sensory Symptoms
  These often occur first, with motor symptoms such as weakness appearing as the condition progresses.

The diagnostic process for Carpal Tunnel Syndrome typically includes:

• Medical History Review
  This involves discussing symptoms and any activities that may aggravate the condition.
• X-rays
  These might be taken to rule out other causes of wrist pain, such as arthritis or a fracture.
• Physical Examination
  The orthopaedic surgeon may conduct various tests to determine the strength of the hand muscles and the sensitivity of the nerves. This might include tapping on the wrist (Tinel’s sign) or bending the wrist for a minute (Phalen’s test) to see if symptoms can be provoked.
• Nerve Conduction Studies
  This test checks the speed of electrical signals in the nerves using small skin electrodes that emit minor impulses. Faster or slower speeds indicate nerve health or damage, respectively. For Carpal Tunnel Syndrome (CTS), it helps identify compression of the median nerve.
• Electromyography (EMG)
  Electromyography, or EMG, is a test that measures the electrical activity of muscles. An orthopaedic surgeon inserts a very thin needle into the muscle to record electrical activity when the muscle is at rest and contracted. This helps to find muscle damage or nerve disorders, including issues related to CTS.
• Ultrasound Imaging
  Ultrasound can visualise the median nerve’s size and may help diagnose CTS. It’s a non-invasive method that can show swelling of the nerve.