Our hands are tools that are essential to everyday life. How many activities do we participate in every day that don’t actually involve our hands in some way? Brushing our teeth, driving a car, writing or typing, eating a meal… All of these tasks require our hands and wrists. When we injure our hands or wrists in some way, it hinders our everyday functioning. However, of the many daily threats to our hands and wrists, one of the most common of these is Carpal Tunnel Syndrome.
Carpal Tunnel Syndrome, or CTS, occurs when the median nerve in the wrist suffers pinching or inflammation. In turn, this compression can lead to pain or immobility in the wrists, hands, or fingers. Our median nerves are the main transmitters of neurological signals to our arms. As such, these nerves run from the shoulder, down the arm, and through the wrist to innervate our hands. Significantly, these important nerves supply movement and sensation to our forearms, thumbs, and the first three fingers of each hand.
These median nerves often encounter obstructions as they travel through the carpal tunnel in the wrist, however. The carpal bones of the wrist—as well as the tendons and ligaments that bind the wrist together—create the carpal tunnel. When someone has a Carpal Tunnel Syndrome diagnosis, this is the area that is most affected.
In addition, a main player in this group of structures is the transverse carpal ligament. This structure covers the median nerve on the inside of the wrist and reduces the volume of the carpal tunnel.
When the carpal tunnel becomes compressed, injured, or swollen, painful symptoms in the wrists, arms, and hands often emerge.
In fact, Carpal Tunnel Syndrome is a very common condition—with millions of cases reported each year in the United States. Common factors that contribute to CTS include:
Possible Causes of Carpal Tunnel Syndrome:
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Although the causes of Carpal Tunnel Syndrome (CTS) can vary, the symptoms tend to be fairly consistent. However, the symptoms can range in severity. And—as a rule of thumb—symptoms tend to develop gradually over time. Common symptoms may include:
Diagnosing Carpal Tunnel:
It is not particularly difficult to determine how to diagnose Carpal Tunnel Syndrome. Nevertheless, there are a number of exams and techniques that can be used to reach a definitive diagnosis. These techniques can help to pinpoint the cause of your CTS and determine the extent of damage to your median nerve.
Some of these exams and tests include:
Physical Exams: Your physician will most likely complete a traditional physical exam of your wrist and hand. This can involve pressing or tapping on the median nerve to assess for pain or tingling; testing sensory reactions in the fingers; or visible examination for weakness (or atrophy) in the muscles at the base of your thumb.
Nerve Conduction Studies: Nerve Conduction Studies employ slight electrical pulses to determine the amount of signal conduction passing through your median nerve. Your doctor will attach electrodes to the hand below the carpal tunnel and measure the strength of the electrical signal.
Ultrasound: This technique uses sound waves to produce an image of the bones and soft tissues in the wrist. In this manner, your doctor can evaluate the degree of swelling and compression that is present.
X-rays: Your doctor may order an X-ray if he/she suspects arthritis or skeletal injuries to be the cause of your CTS.
MRIs: MRIs are helpful in producing detailed images of soft tissues in the wrist. These imaging techniques can be used to determine if scarring, tumors, or other soft tissue injuries are present.
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Carpal Tunnel Syndrome (CTS) is a widespread condition that is fortunately very treatable. At NJ Spine & Ortho, many of our board certified surgeons have over 20 years of experience in resolving Carpal Tunnel Syndrome! Common treatment options that our spine specialists may recommend include:
Bracing or Splinting: Bracing and splinting techniques encourage individuals with CTS to keep their wrists straight instead of bent. This allows for uninterrupted healing time and promotes decreased inflammation during the daytime and while sleeping at night.
Physical Therapy: A physical therapist can develop a regimen of exercises to promote pain relief and strength-building in your wrist and hand. He or she can also design alternatives to your everyday activities that will avoid future CTS complications. This may involve examining the activities that you engage in every day. Or, retraining your arm and hand posture to prevent future reoccurrences of CTS.
Medication: Anti-inflammatory medications, such as ibuprofen or naproxen, may provide sufficient pain relief for those with mild CTS.
Corticosteroid Injections: Steroidal injections are a short-term pain management option for those with moderate to severe pain in the wrist.
Surgery: The main surgical procedure performed for Carpal Tunnel Syndrome is a minimally invasive Endoscopic Carpal Tunnel Release. In this outpatient procedure, your hand surgeon will insert an endoscope through the palm to visualize problematic structures in the hand. Then, your surgeon will create more space in the tunnel by releasing the transverse carpal ligament. Typically completed as an outpatient procedure, you can expect to experience no blood loss and a very speedy recovery from this operation.
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