Carpal Tunnel Syndrome (CTS) is a common condition affecting over 2.5 million people in the USA. RALI will review common questions regarding this problem and to help you know if you have it.
What is CTS?
CTS is a syndrome caused by compression of the median nerve in the wrist. The nerve is surrounded by the tendons that move the fingers and these structures are in the wrist within underneath the carpal ligament. This ligament attaches to the bones of the wrist and the median nerve and 9 tendons pass underneath it. When the tendons are overused they swell up and put pressure on the nerve. This causes pain and numbness that affects the thumb and the next 3 fingers. It does not affect the little finger.
How do I know if I have CTS?
CTS is characterized by pain in the wrist and numbness of the first 4 fingers of the hand. You may also experience weakness or clumsiness of the hand. The symptoms may awaken you from sleep and be worsened by lifting, keyboard use, holding a steering wheel, gardening or anything that causes repetitive movements of the wrists or tensing of the forearm muscles. Some people complain of dropping things like cups or bottles due to the pain and weakness in thier hand.
Are some people at a greater risk of developing this condition?
Yes, some medical conditions are associated with CTS in over 50% of the patients. These conditions include diabetes, thyroid disease, rheumatoid arthritis, pregnancy and wrist fracture. Also occupations such as electrcians, carpenters, contractors, and secretaries have a higher incidence of CTS
How is the diagnosis made?
For the most part the diagnosis is based on the history and physical examination of the patient. It is important to realize that many other common problems can cause similar complaints. A thorough examination to distinguish CTS from a pinched nerve in the neck, wrist sprain, peripheral neuropathy, and other problems needs to be carried out to ensure your proper treatment. At RALI we have much experience with the diagnosis and treatment of CTS.
What tests are important?
Routine blood work, wrist x-ray and nerve tests are usually done. Nerve conduction tests are very sensitive for diagnosing CTS and they also give information regarding how badly compressed the nerve is.
What treatments are there?
The first treatment is usually non-surgical in nature. Comprehensive non-surgical treatments are available that combines mobilization and stretching of the carpal tunnel to decrease the pressure on the median nerve. These techniques are combined with bracing, paraffin baths, ultrasound and medications including compound creams using Gabapentin and antiinflammatory medications. These topical creams help decrease the swelling and pressure within the carpal tunnel. This allows the median nerve to heal. For most patients, these simple techniques are all that is needed, however a local injection of steroid may also be helpful.
What about surgery
Surgery is done in cases that don’t respond to conservative treatment. Basically, there are 2 types of surgical procedures, endoscopic and open.
Are there complications from surgery?
Yes. Complications of carpal tunnel surgery include damage to the median nerve, infection, tendon damage and reflex sympathetic dystrophy. These complications are more common in endoscopic procedures due to the restricted view of the wrist structures. It is important to note that the most frequent reason for failure of carpal tunnel surgery is an incorrect diagnosis. Therefore it is very important that you have a complete workup including nerve testing. In the hands of a good surgeon with a clear-cut diagnosis of CTS , the complications of surgery are very small.
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