What is carpal tunnel syndrome (CTS)?

Carpal tunnel syndrome is symptoms and signs that occur from median nerve entrapment at the wrist. Typical symptoms include:

  • Feeling that the hand falls asleep (tingling and/or numbness)
  • Loss of grip strength or dropping items out of the hands
  • Weakness or clumsiness of the hand
  • Feeling that the hands are tight, swollen, or cold
  • Pain in hand or wrist particularly at night
  • The pain can be present from the shoulder to the hand.

What causes CTS?

It is caused by compression of the median nerve at the wrist. The median nerve is a nerve in the arm that supplies muscles of the hand. The nerve is compressed by a tight tendinous sheath called the flexor retinaculum. There is a high association with this condition and individuals with:

  • Wrist injury or fracture
  • Conditions such as diabetes, thyroid disorders, rheumatoid arthritis
  • Vocational activities such as typing or other repetitive movements with hands
  • Pregnancy or obesity
  • Use of wheelchairs or walking aids

This condition is more common in women.

How is CTS diagnosed?

With electromyography (EMG) and nerve conduction study (NCS). This is a test to examine the nerves traveling from the neck all the way down to the fingers.  This test can detect abnormalities in the median nerve (the nerve involved in CTS), and also rule out other conditions (i.e. pinched nerve in the neck). We offer testing for this at our facility with one of our Board Certified Physicians.

How is CTS treated?

The treatment depends on the severity of CTS.

If it is mild or moderate (as diagnosed on EMG/NCS), physical therapy (for aerobic fitness, stretching, and ultrasound treatments), occupational therapy (to improved ergonomics at work and strengthen hands and wrists), or steroid injection can be of benefit. A short course of NSAIDs (i.e. ibuprofen) can also help.

If the disease is severe, surgical release of the tendinous sheath in the wrist is indicated. We can assist in treatment of this condition at our practice.

If you have some of these symptoms, ask your doctor for a referral to Comprehensive Rehabilitation and Pain Specialists for electrodiagnostic testing.