Health Care

By Anna Moustafellou

At a glance

Carpal tunnel syndrome results when one of the two nerves that are responsible for sensation and movement of the hand (called the median nerve) is being "squeezed" inside the carpal tunnel, on its way from the forearm to the wrist and palm.The carpal tunnel is a small tube-like structure running from the bottom of the wrist to the lower palm and makes a path through which the median nerve and many tendons of the muscles that bend the fingers pass. It is made of bones and connective tissue, the latter forming a structure called the transverse ligament, which seals the tunnel on the inner side of the wrist.

When the space inside the tunnel becomes narrower (like when there is swelling of the area), the median nerve is compressed and is made dysfunctional, due to the increased interstitial pressure.

What are the causes of CTS?

Anything that can cause chronic swelling inside the carpal tunnel is a potential cause of carpal tunnel syndrome. The most common reason for this is inflammation of the tendons of the muscles that bend the wrist and fingers (tendonitis), as a result of overwork. Repetitive small movements of the wrist (mostly bending) are especially guilty of causing overwork, so professionals who have to constantly use their hands (such as hairdressers, programmers and athletes) are in highest risk.

The increased incidence of CTS among teenagers lately indicates that the use of computers and video game consoles may also be responsible.

Other causes of CTS include inflammatory diseases of the musculoskeletal system (such as osteoarthritis and rheumatoid arthritis) and old fractures of the wrist. Moreover, hormonal changes during pregnancy can cause CTS, probably because of water retention. When CTS is caused by pregnancy, it often goes away on its own after delivery. In addition, diabetes can be a cause of carpal tunnel syndrome, as peripheral neuropathy is a frequent complication of this disease. Finally, hypothyroidism is another endocrine disorder associated with CTS.

Generally, the syndrome affects most frequently women between 40-60 years of age, as the carpal tunnel is narrower in females, although it could also be that women overwork their hands being responsible for housekeeping.

What are the symptoms of CTS?

The median nerve does not spread throughout the whole hand but is only responsible for sensation and movement of the thumb, the index and middle fingers, the tip of the ring finger and only half of the palm (the side next to the thumb). Therefore problems appear mostly in these areas. You should keep that in mind as in the case where your symptoms are first experienced in your pinky finger, it most probably isn't carpal tunnel syndrome (e.g. median nerve compression). Rather, the second nerve we mentioned earlier is the root of the problem (which is called the ulnar nerve).

The basic symptoms of carpal tunnel syndrome are:

* pain
* "pins and needles"
* tingling
* numbness (the patient often feels as if his hand "falls asleep" or describes it as "going dead") and
* reduction of hand strength and mobility

Moreover, there can be dryness and change of the color of the skin, swelling (edema) of the hand and decreased muscle mass below the thumb (muscle atrophy).

It is important to understand that the severity of the symptoms varies greatly among patients. That being said, symptoms can be limited to just numbness and tingling now and then, but can also include pain that awakens the patient at night or that radiates through the forearm and arm all the way up to the shoulder. Generally, carpal tunnel syndrome is thought to be a progressively worsening condition, its symptoms getting more and more frequent and severe, although this has not been scientifically proved. Rarely, if left untreated, CTS can result in permanent decrease in the mobility of the wrist and fingers.

How is CTS treated once it's diagnosed?

The therapeutic options for carpal tunnel syndrome differ depending on the severity of each case. When the symptoms are mild to moderate, a wrist splint can be applied and is usually worn at night to help stabilize the hand in a position that prevents bending during sleep. If the wrist splint hasn't made a difference in alleviating the symptoms after two months, then the patient can have corticosteroid injections that reduce the inflammation inside the carpal tunnel, thus decreasing the pressure on the median nerve.

Of course, when CTS is caused by an underlying disease, such as hypothyroidism or rheumatoid arthritis, efforts must be made to treat the disease in question.

For severe cases of CTS or when the other treatments have not managed to relieve the patient's symptoms, hand surgery can be considered. During surgery for CTS, the surgeon cuts the transverse ligament that seals the carpal tunnel, making the space inside it wider. In that way, the structures that are enclosed in it are decompressed and the pressure on the median nerve is alleviated.

Though CTS surgery is only considered for severe or chronic cases, its results are usually very satisfactory, relieving almost all symptoms. However, the usual post-operative complications still apply and it is always wise to remember that the earlier one seeks medical attention for CTS, the better are the outcomes of the treatment. Therefore, one should visit a neurologist as soon as the first symptoms of CTS appear, bearing in mind that early detection is key.

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