Capal Tunnel Syndrome (CTS) 101
Carpal Tunnel Syndrome (CTS) is one of the most common hand afflictions. It is also a diagnosis that is often incorrectly termed for patients presenting with a variety of very different signs and symptoms. To dispel some of the misconceptions about Carpal Tunnel Syndrome, this article will address CTS from the perspective of Chicago hand surgeon Dr. Norman Weinzweig taking into account the confusion that often exists about this condition.
What is Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is a condition that results from a “pinched nerve” in the wrist. This nerve, better known as the median nerve, is surrounded by nine (9) tendons as it travels from the forearm into the wrist through a canal hooded by the transverse carpal ligament. Constriction of the canal by a thickened transverse carpal ligament or swelling within the canal compresses the median nerve causing pain, numbness and tingling of the hand and digits.
Symptoms of Carpal Tunnel Syndrome
These symptoms usually affect the thumb, index, middle and radial half of the ring finger (side closest to the thumb). However, any or all of these digits may be involved since the median nerve supplies all of them with sensation. Different parts of the median nerve can be compressed and to different degrees, however, the most common and classic presentation involves most, if not all, of these digits.
Symptoms of CTS may vary but general invole pain, tingling or numbness or some combination of all three. The thumb, index, middle and radial half of the ring finger are most commonly involved. Often, the patient relates how he or she wakes up several times during the night with these symptoms. Patients often drop things due to diminished grip strength. Symptoms may occur during driving or hold a newspaper due to the flexed position of the wrist.
Involvement of the Ulnar Nerve in Carpal Tunnel Syndrome
Often, similar symptoms are seen in the ulnar half of the ring finger (closest to the little finger) and the little finger. This is not due to Carpal Tunnel Syndrome but rather compression of the ulnar nerve in Guyon’s Canal at the level of the wrist. Often, the two (2) conditions coexist as the median and ulnar nerves are in close anatomic proximity at the level of the wrist. In approximately 75% of cases, carpal tunnel release will also relieve the ulnar nerve symptoms. Nonetheless, if all digits demonstrate pain, numbness and tingling, the ulnar nerve should be released or decompressed at the same time that carpal tunnel release is performed.
Causes of Carpal Tunnel Syndrome
There is no one cause for Carpal Tunnel Syndrome. There are a variety of activities that have been associated with CTS, some of them repetitive in nature (though there is significant controversy in the literature) as well as several medical conditions such as diabetes, thyroid disease and arthritis that can be associated with CTS. Even pregnancy has been associated with CTS due to increased water retention with the symptomatology often spontaneously resolving after pregnancy.
Diagnosing Carpal Tunnel Syndrome
Dr. Norman Weinzweig looks at a detailed history before making the diagnosis. This should include past injuries, daily activities at home and at the workplace, and history of diabetes, throid disease or arthritis. Physical examination will entail evlaluation of fingertip sensation, grip strength, testing for Phalen’s sign (manifestation of symptoms with flexion at the wrist) and Tinel’s sign (radiation of symptoms with tapping of the median nerve at the level of the wrist). X-rays should be done to evaluate for arthritis or fractures. Other more proximal entrapment neuropathies such as Pronator Syndrome (compression of the median nerve more proximally in the forearm) or Cervical Radiculopathy (often due to injury of the nerve at the level of the neck such as after an automobile accident) should be ruled out. Lastly, the diagnosis should be corroborated by using Electrodiagnostic Studies such as Nerve conduction velocity and electromyogram.
Carpal Tunnel Syndrome Treatment Options
Surgery is not always indicated to treat symptoms. Often, treat,ment may be as simple as using a wrist splint or avoiding activities that aggravate symptoms, such as repetitive motion. Non-steroidal anti-inflammatory agents may also reduce swelling and reduce symptoms. Steroids may be injected into the carpal tunnel to reduce swelling and thereby eliminate symptoms. When this works, it is usually prognostic of a favorable outcome following surgery. Lastly, surgery may be required if these non-surgical methods don’t relieve symptoms. The goal of surgery is to relieve nerve pressure by cutiing the constricting transverse carpal ligament. It must be completely cut or symptoms may not be relieved. Symptoms may be relieved immediately or in progressive fashion over several weks. Restoration of hand strength may take several months. In severe cases, this recovery may be limited dure to irreversible injury to the nerve and/or the tiny intrinsic muscle that are innervated by the nerve. Usually, symptoms are improved, often times, dramatically.
While Carpal Tunnel Release is a very commonly performed procedure, it must be done very carefully to avoid possible injury to the median nerve. Postoperative rehabilitation is also very important. At the CHICAGO INSTITUTE FOR HAND SURGERY, Dr. Norman Weinzweig has performed hundreds of these procedures. Certified hand therapist or occupational therapist assist with the postoperative rehabilitation to get the patient back to normal activities and the workplace as soon as possible.