Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a common condition that causes pain, numbness, and tingling in the hand and arm. It occurs when the median nerve, one of the major nerves of the hand, is compressed as it travels through the carpal tunnel—a narrow passageway of ligament and bones at the base of the hand. The median nerve controls sensation and muscle movement in the thumb and first three fingers (but not the little finger). Various factors can cause the carpal tunnel to narrow or the tissues within it to swell, putting pressure on the median nerve. Early diagnosis and treatment are important to prevent permanent nerve damage and worsening symptoms. CTS is more common in women than men and typically affects people between 30 and 60 years of age. With appropriate treatment, symptoms can often be relieved without surgery, though more severe cases may require surgical intervention.

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What Causes It?

Repetitive hand movements - Especially activities involving extreme flexion or extension of the wrist, like typing, using a mouse, or manual labor.

Anatomical factors - Naturally narrow carpal tunnel or wrist fracture/dislocation that alters the space.

Sex - Women are three times more likely to develop CTS, possibly due to naturally smaller carpal tunnels.

Heredity - Family history can play a role in susceptibility to CTS.

Pregnancy - Hormonal changes and fluid retention can cause swelling in the carpal tunnel.

Inflammatory conditions - Rheumatoid arthritis and other inflammatory conditions can affect the tendons in the wrist.

Obesity - Higher body mass index is associated with increased risk.

Diabetes - Can affect the nerves, making them more susceptible to compression.

Thyroid disorders - Both hypothyroidism and hyperthyroidism can contribute to CTS.

Renal (kidney) failure - Can lead to fluid retention and nerve pressure.

Menopause - Hormonal changes may play a role.

Workplace factors - Vibrating tools, cold environments, and awkward wrist positions increase risk.

Previous wrist injuries - Sprains, strains, or fractures can alter wrist anatomy.

Signs & Symptoms

Numbness, tingling, or "pins and needles" sensation in the thumb, index, middle, and half of the ring finger.

Pain or burning in the hand and wrist that may radiate up the arm to the shoulder.

Weakened grip strength and difficulty with fine motor tasks like buttoning clothes or picking up small objects.

Tendency to drop objects due to numbness or weakness.

Symptoms that worsen at night or early morning, often waking the person from sleep.

Discomfort that may be relieved temporarily by "shaking out" the hand.

Symptoms that worsen with activities that involve flexing the wrist, like driving, reading a book, or typing.

Sensation of swelling in fingers, even without visible swelling.

In advanced cases, atrophy (wasting) of the thenar muscles at the base of the thumb.

Dry skin, swelling, or color changes in the hand due to autonomic symptoms.

Symptoms typically begin gradually and worsen over time without treatment.

In some cases, symptoms may initially come and go but eventually become more constant.

Little finger remains unaffected (an important diagnostic clue, as the median nerve doesn't supply this finger).

How We Diagnose

Our specialists use advanced diagnostic methods to accurately identify and assess your condition

Medical History and Physical Examination

Your doctor will review your symptoms, medical conditions, and daily activities, then examine your hand, wrist, shoulder, and neck. They may test sensation, check for muscle weakness or atrophy, and perform specific tests like the Tinel test (tapping over the median nerve) or Phalen's test (holding the wrists flexed).

Nerve Conduction Studies

Measures how quickly electrical impulses move through the median nerve. Slowed conduction indicates compression. This test can determine the severity of nerve compression and help rule out other conditions with similar symptoms.

Electromyography (EMG)

Often performed with nerve conduction studies, this test measures the electrical activity in muscles when they contract and when at rest. It can detect muscle damage resulting from median nerve compression and help distinguish CTS from other nerve disorders.

Ultrasound

Creates images of the median nerve and surrounding structures using sound waves. Can show if the nerve is flattened or swollen and identify other causes of compression like ganglion cysts or abnormal blood vessels.

X-rays

While not used to diagnose CTS directly, X-rays can reveal arthritis, fractures, or other bone abnormalities that might contribute to symptoms by narrowing the carpal tunnel.

MRI

Provides detailed images of soft tissues, showing the anatomy of the carpal tunnel, median nerve, and surrounding structures. Usually reserved for complex cases or when other causes of symptoms are suspected.

Blood Tests

May be ordered to check for underlying conditions associated with CTS, such as diabetes, thyroid disorders, or rheumatoid arthritis.

Treatment Options

Personalized treatment plans tailored to your specific needs and condition

Wrist Splinting

Wearing a splint that holds the wrist in a neutral position, especially during sleep, can relieve pressure on the median nerve. This is often the first-line treatment for mild to moderate CTS and may provide significant relief, particularly for nighttime symptoms.

Activity Modifications

Changing hand positions, taking frequent breaks from repetitive tasks, improving workplace ergonomics, and avoiding activities that worsen symptoms can help reduce pressure on the median nerve. Proper positioning of computer keyboards and mice is particularly important.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Over-the-counter medications like ibuprofen or naproxen may temporarily reduce pain and inflammation, though they don't address the underlying compression of the median nerve. These are most helpful for short-term symptom relief.

Corticosteroid Injections

An injection of corticosteroid medication into the carpal tunnel can reduce inflammation and swelling, providing temporary relief that may last weeks to months. This can be particularly helpful for symptoms that flare during pregnancy or other temporary conditions.

Physical Therapy

A physical or occupational therapist can teach nerve gliding exercises, stretching techniques, and strengthening exercises for the wrist and hand. They can also provide guidance on ergonomics and activity modifications to reduce symptoms.

Carpal Tunnel Release Surgery

For persistent or severe symptoms, surgery to cut the transverse carpal ligament and enlarge the carpal tunnel may be recommended. This can be performed as an open procedure or endoscopically, with both approaches being effective. Surgery typically provides rapid symptom relief, though full recovery may take several months.

Alternative Therapies

Some patients find relief with acupuncture, yoga, or chiropractic care, though scientific evidence for these approaches varies. These therapies may be most beneficial when combined with conventional treatments.

Home Remedies

Wrist Exercises and Stretches

Gentle stretching of the wrist and hand can help relieve pressure on the median nerve. Try extending your arm with palm up, then gently pull fingers back toward your body with the other hand, holding for 15-30 seconds. Repeat with palm down. Perform nerve gliding exercises as demonstrated by a healthcare provider.

Ice Therapy

Apply an ice pack to the wrist for 10-15 minutes every hour or two to reduce inflammation and swelling. Always wrap ice in a thin towel to protect your skin. Some people find alternating between ice and heat provides better relief.

Ergonomic Adjustments

Make your workspace more hand-friendly by adjusting the height of your chair and desk so wrists remain in a neutral position (not bent up or down). Use an ergonomic keyboard, mouse pad with wrist support, and proper positioning of frequently used items to minimize strain.

Take Breaks

During repetitive activities, take a 3-5 minute break every 20-30 minutes. Use this time to stretch your hands, wrists, and arms. Setting a timer can help remind you when it's time for a break.

Over-the-Counter Pain Relievers

NSAIDs like ibuprofen or naproxen can temporarily reduce pain and inflammation. Follow package directions and consult your doctor if you have underlying health conditions or take other medications.

Nighttime Wrist Support

Wear a wrist splint during sleep to keep your wrist in a neutral position. Look for splints specifically designed for carpal tunnel syndrome, which typically immobilize the wrist but allow finger movement.

Vitamin B6 Supplementation

Some studies suggest vitamin B6 may help relieve CTS symptoms, though evidence is mixed. If considering supplements, discuss with your healthcare provider regarding appropriate dosage, as excessive B6 can cause nerve problems.

Hand Warm-Up

Before engaging in activities that require repetitive hand movements, warm up your hands and wrists with gentle movements and stretches, similar to how athletes warm up before exercise.

Prevention Tips

Take frequent breaks from repetitive activities to rest your hands and wrists.

Maintain proper posture and wrist position when using a computer or performing hand-intensive tasks.

Keep wrists in a neutral (straight) position when working, not bent up or down.

Use ergonomic tools designed to reduce strain, such as split keyboards or vertical computer mice.

Adjust your workstation to optimize wrist position (chair height, desk height, keyboard position).

Rotate tasks to avoid performing the same hand and wrist motions for extended periods.

Stretch and strengthen hand and wrist muscles regularly with appropriate exercises.

Keep hands warm while working, as cold environments can worsen symptoms and increase stiffness.

Address underlying health conditions that may contribute to CTS, such as diabetes or arthritis.

Maintain a healthy weight, as obesity is a risk factor for carpal tunnel syndrome.

Use proper form when performing activities requiring wrist movements, especially during exercise.

Reduce force and pressure when performing hand tasks; hold tools and objects gently.

Wear wrist splints during activities that tend to aggravate symptoms.

Consider preventive splinting at night if you have early symptoms or high-risk occupations.

Surgical Solutions

Advanced surgical procedures performed by our expert specialists

Open Carpal Tunnel Release

The traditional surgical approach where a surgeon makes an incision (about 2 inches) in the palm over the carpal tunnel and cuts the transverse carpal ligament to relieve pressure on the median nerve. This procedure provides excellent visualization of structures and allows the surgeon to address any other abnormalities found during surgery. Recovery typically involves restrictions for 2-4 weeks, with gradual return to normal activities over 6-12 weeks.

Endoscopic Carpal Tunnel Release

A minimally invasive approach using one or two small incisions in the wrist and/or palm. A thin tube with a camera (endoscope) allows the surgeon to see inside the carpal tunnel and cut the transverse carpal ligament using specialized instruments. This technique typically results in less post-operative pain, faster recovery, and smaller scars compared to open surgery, though it requires specialized equipment and expertise.

Mini-Open Carpal Tunnel Release

A hybrid approach using a smaller incision (about 1 inch) than traditional open surgery but without endoscopic equipment. This technique balances the advantages of direct visualization with smaller incision size and potentially faster recovery than traditional open surgery.

Revision Carpal Tunnel Surgery

For recurrent or persistent carpal tunnel syndrome after a previous release, a second surgery may be necessary. This is more complex than primary surgery due to scar tissue and altered anatomy. The approach may involve extensive release of scar tissue, neurolysis (freeing the nerve from surrounding tissue), or in some cases, procedures to protect the nerve such as fat pad transfer or hypothenar muscle flap.

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