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Carpal Tunnel Syndrome
Dr. Chee Kin Ghee
What is Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) is a condition characterised by pain, numbness, tingling, and weakness in the hand and wrist. It arises when the median nerve, which extends from the forearm into the palm, is compressed or squeezed at the wrist.
This nerve, responsible for providing sensation in several fingers, passes through the carpal tunnel, a narrow and rigid passageway of ligament and bones at the hand’s base. When pressure within this tunnel increases, typically due to swelling or anatomical changes, it leads to the symptoms associated with CTS.
Prolonged compression of the nerve can result in debilitating loss of sensation and pain, potentially leading to functional impairment, as well as muscle atrophy or muscle wasting.
Symptoms
CTS manifests through a variety of symptoms, which typically evolve over time. It can affect one or both hands, often starting with the dominant hand.
- Numbness and Tingling
Frequent numbness or tingling in the fingers, especially the thumb, index, and middle fingers, is common. This sensation may initially appear at night and can awaken individuals from sleep. In the early stages, shaking of the hands can provide temporary relief. - Pain
Individuals may experience pain in the hand and wrist, which can extend up the arm. This pain is often more pronounced at night. - Weakened Hand Function
As CTS progresses, there can be a decrease in grip strength and dexterity, making it challenging to perform fine motor tasks such as buttoning clothes or handling small objects. - Muscle Atrophy
In severe cases, the muscles at the base of the thumb may waste away, leading to noticeable changes in hand appearance and further diminishing hand function. - Sensory Changes
Some individuals with advanced CTS may lose the ability to differentiate between hot and cold by touch, increasing the risk of burns or injuries.
Causes and Risk Factors
CTS is typically the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel.
- Repetitive Hand Use: Extensive wrist and hand movements, especially those involving high force or vibration, can aggravate the tendons in the carpal tunnel and lead to swelling.
- Wrist Position: Activities or postures that involve extreme flexion or extension of the wrist can increase pressure on the nerve.
- Anatomical Factors: A smaller carpal tunnel, which can be hereditary, increases the risk of nerve compression. Wrist fractures and dislocations can also alter the space within the carpal tunnel, contributing to CTS.
- Health Conditions: Rheumatoid arthritis, diabetes, thyroid gland imbalances, and fluid retention during pregnancy or menopause are known to be associated with CTS.
- Gender and Age: Women are more likely to develop CTS, possibly due to having smaller carpal tunnels. CTS is more common in adults, especially those over the age of 50.
- Workplace Factors: Jobs that involve repetitive wrist motions, or the use of vibrating tools, can increase the risk of developing CTS.
Diagnosis
Diagnosing CTS typically involves a combination of clinical examination and specific tests.
- Clinical Examination
A doctor will examine the hands, arms, and neck to rule out other conditions and assess for signs of CTS, such as swelling, tenderness, and muscle weakness in the hand. - Nerve Conduction Studies
These tests measure the speed and strength of electrical impulses as they travel through the median nerve, helping confirm the diagnosis. - Electromyography (EMG)
This test evaluates the electrical activity in muscles, identifying nerve damage. - X-rays or Ultrasound
Imaging tests may be used to exclude other causes of wrist pain, like arthritis or fractures, or to view the anatomy of the wrist.
Non-Surgical Treatment Options
Non-surgical treatments are often the first approach to managing CTS, especially in its early stages. These treatments focus on relieving symptoms and preventing further nerve damage.
- Wrist Splinting
Wearing a splint at night keeps the wrist in a neutral position, reducing pressure on the median nerve. - Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) may alleviate pain and inflammation. In some cases, corticosteroid injections are used to reduce swelling and relieve pressure on the median nerve. - Physical Therapy
A physical therapist may recommend exercises and stretches designed to strengthen the hand and wrist. These can help improve symptoms and prevent muscle weakness. - Alternative Therapies
Some patients find relief through alternative approaches such as yoga, acupuncture, or chiropractic care, although the effectiveness of these treatments can vary.
Surgical Treatment Options
When non-surgical treatments do not provide sufficient relief, or if CTS is severe, surgery may be conducted. The most common surgical procedure is the carpal tunnel release, which involves cutting the ligament that forms the roof of the carpal tunnel to reduce pressure on the median nerve. This is conducted under local anaesthesia. It can be performed using two different methods:
Open Release Surgery
This traditional method involves making a larger incision in the palm of the hand, allowing the surgeon direct visibility and access to the transverse carpal ligament. The ligament is then cut to release the pressure on the median nerve.
The open nature of this surgery allows the surgeon to directly view the treatment area, but it may result in a longer recovery period and more discomfort postoperatively compared to endoscopic surgery.
Endoscopic Surgery
A more recent, minimally invasive technique, endoscopic surgery involves one or two small incisions in the wrist and palm. A camera (endoscope) is inserted, which guides the surgeon to the transverse carpal ligament. Specialised instruments are then used to cut the ligament.
This method typically results in a quicker recovery, less postoperative pain, and smaller scars. It may carry a slightly higher risk of complications and might not be suitable for all patients, depending on the specifics of their condition.
Prevention Strategies
Preventing CTS involves measures to reduce stress on the hands and wrists.
- Maintaining a Neutral Wrist Position
Adjusting chair height, keyboard placement, and tool handles helps to maintain a neutral wrist position during long periods of work. - Sufficient Rest From Strenuous Activities
Taking short breaks from repetitive activities to stretch and rest the hands and wrists. - Hand and Wrist Strengthening Exercises
Strengthening exercises can improve flexibility and reduce the risk of injury. - Mindful Sleeping Positions
Keeping wrists straight during sleep to prevent prolonged bending or pressure.
Our Clinic Locations
Spire Hand & Upper Limb Centre
3 Mount Elizabeth, #07-10
Singapore 228510
Monday – Friday: 9.00am – 6.00 pm
Saturday: 9.00am – 1.00pm
Sunday & PH: CLOSED
Spire Orthopaedic Physiotherapy & Rehab Centre
101 Irrawaddy Road, #18-03
Singapore 329565
Monday – Friday: 9.00am – 6.00 pm
Saturday: 9.00am – 1.00pm
Sunday & PH: CLOSED
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Frequently Asked Questions (FAQ)
Can Carpal Tunnel Syndrome be cured without surgery?
Yes, in many cases, especially if diagnosed early, non-surgical treatments like splinting, lifestyle modifications, and medications can effectively manage the condition.
How long is the recovery period after Carpal Tunnel surgery?
Recovery varies but typically involves a few weeks for basic hand function to return, with full recovery taking several months.
Can changes in diet or lifestyle help with Carpal Tunnel Syndrome?
While a change in the diet itself does not directly affect CTS, maintaining a healthy weight and managing health conditions like diabetes can reduce the risk of developing the condition.