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Carpal tunnel syndrome - Orthopaedics SA

Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome or CTS refers to the painful condition affecting the wrist and hand.

The carpal tunnel is formed by the wrist bones and the carpal tunnel ligament. The median nerve (which supplies sensation to the thumb, index and middle fingers) and the tendons (which allow movement of the hand and fingers) pass through the carpal tunnel.

More commonly affecting women than men, CTS occurs when there is compression or pinching of the median nerve.

The most common signs of CTS include:

  • Pain in the hand, wrist and arm often felt during the night
  • Grip weakness and reduced ability to grasp small objects
  • Numbness and tingling in the hand
  • Pins and needles

Common causes of CTS include:

  • Trauma or injury such as a fracture or sprain
  • Fluid retention during pregnancy
  • Rheumatoid arthritis
  • Diabetes

In many cases there is no obvious reason for the onset of symptoms. With only a small amount of available space in the carpal tunnel, any swelling of the surrounding tissue can cause median nerve compression.

Your doctor will conduct an examination and take a detailed history to establish signs, symptoms and risk factors and to rule out any underlying injury.

If required, a nerve conduction study (NCS) or electromyogram (EMG) may be arranged to check for abnormalities in nerve function.

Depending on the severity of symptoms and the stage of disease, conservative treatment options may include:

  • Resting the hands from repetitive activities
  • Ice packs to reduce any swelling
  • Non-steroidal anti-inflammatory medication
  • Wrist splints worn at night to stabilise the wrist in a neutral position during sleep
  • A steroid injection into the carpal tunnel to decrease inflammation and reduce pain.

Surgical treatment may be considered where symptoms are severe. This commonly performed procedure is done by cutting the ligament which forms the roof of the carpal tunnel to increase space and reduce the pressure on the median nerve.

A Carpal Tunnel Release can be an ‘open’ procedure where an incision is made in the palm of the hand or via an endoscope where a smaller incision is made through which a tiny camera and instruments are inserted to release the nerve. Most people experience a significant improvement after surgery although it is not uncommon to have some residual numbness, weakness or pain. In most instances this will resolve, however in a small number of cases some numbness may be permanent. Following surgery your doctor will give you guidelines for returning to your normal activities. It may be several weeks or even months before you are able to use your hands without restriction.

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