Carpal Tunnel Syndrome (CTS) is the name attached to a compression o the median nerve at the wrist. The median nerve supplies sensation (touch) to part of the hand. It also innervates (supplies nerve impulses to) certain muscles in the hand. When the nerve is compressed, the patient may feel numbness, pain, and weakness in parts of the hand.
Some anatomy is needed to understand CTS. The "tunnel" is actually the space where the median nerve goes across the wrist along with some of the tendons that flex the fingers and the thumb. The floor and walls of the "tunnel" are made of the small carpal bones of the wrist. The roof of the "tunnel" is formed by a ligament that runs between the carpal bones that make up the walls of the "tunnel". This ligament is called the transverse carpal ligament.
What causes CTS? Anything that takes up space in the carpal tunnel can cause CTS. Remember, the floors and walls are made of hard bone. The roof is a tight ligament that does not give much if any. Therefore, there is a limited space in the "tunnel".
The most frequent cause is flexor tenosynovitis. This is an inflammation of the flexor tendons. Remember again, these tendons run inside the "tunnel" along with the median nerve. This tendinitis, irritation of the tendons, can have many causes. The most common is overuse or repetitive use injury. Examples include riding a bicycle with wrist bent for an hour or using scissors with the wrist bent and tight (flexed) fingers. Chronic overuse, such as computer work, can cause tendon inflammation. Another less common cause can be systemic (whole body) inflammatory condition that inflames the tendons. This is similar to some types of arthritis.
Fractures of the wrist can cause changes in the bones that make up the floor and walls of the "tunnel" that leads to CTS. The swelling associated with these injuries can take up the space needed for the nerve and tendons. This type of CTS, called acute CTS is actually more of an urgent problem that usually requires surgery.
Less common causes such as a tumor in the carpal canal must also be considered. These are relatively rare.
CTS is usually first treated conservatively and anti-inflammatory medicine and rest. Avoiding or modifying the repetitive activity or the presumed activity that caused the CTS is recommended. Exercises may be tried. A splint to hold the wrist in a neutral (straight) position may be used.
Nerve studies called EMG (Electromyelography) and NCV (Nerve Conduction Velocity) are sometimes used to confirm the diagnosis.
When conservative treatment fails, surgery may be advised. Surgery involves cutting the transverse carpal ligament (roof) to in effect open-up the "tunnel". Open surgery and arthroscopic surgery are both used. The open surgery is more traditional. Arthroscopic treatment is somewhat new but has been done successfully for several years. There is some question of the rue benefits of arthroscopic surgery versus open surgery at this time.
If symptoms of pain in the hand, especially pain or numbness during sleep are present, you may have CTS. If an activity that may have caused CTS can be identified, the activity should be modified or discontinued. If the pain, numbness, or weakness continues, check with your doctor or orthopedic surgeon.
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