Carpal Tunnel Syndrome (CTS)

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is a pressure-induced neuropathy that causes sensorimotor disturbances of the median nerve, which impair functional ability. A clear history which elicits relevant work exposures that causes repetitive injury to wrist joint can lead to an accurate diagnosis. 

Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Women are three times more commonly affected than men of the same age. Obesity, diabetes mellitus, thyroid disorders, rheumatoid arthritis, previous wrist factures, and pregnancy are well-established risk factors for CTS. 

The gender differences may be explained at least partly by hormonal factors as pregnant and breast feeding women have increased risk of carpal tunnel syndrome, as well as those in their first menopausal year, taking the oral contraceptive pill or taking hormone replacement therapy and oophorectomy appears to reduce the incidence. Body mass index and obesity are strongly associated with carpal tunnel syndrome.

What are the Sign and Symptoms of Carpal Tunnel Syndrome?

Carpal tunnel syndrome causes 

  • Pain worse at night or in the early morning
  • Loss of feeling in your thumb, index finger, middle finger, and part of your ring finger, numbness, tingling.
  • Weakness in your hand may be a sign of carpal tunnel syndrome that is caused by pressure on the median nerve as it travels through the carpal tunnel. 

Nearly 50% of all work-related injuries are linked to carpal tunnel syndrome, and people with this injury are more likely to miss work because of it.

How Carpal Tunnel Syndrome (CTS) is diagnosed?

Wrist pain due to arthritis or tendonitis may mimic Carpal Tunnel Syndrome.

Different provocative tests have been described and have variable accuracy. These include The Phalen's wrist flexion and the carpal compression tests which have the highest overall accuracy, while Tinel's nerve percussion test is more specific to axonal damage that may occur as a result of moderate to severe CTS.

Sensory evaluation of light touch, vibration, or current perception thresholds can detect early sensory changes, whereas 2-point discrimination changes and thenar atrophy indicate loss of nerve fibres occurring with more severe disease.

Electrodiagnosis can encompass a variety of tests and is commonly used to assess the presence/severity of neuropathic changes and to preclude alternative diagnoses that overlap with CTS in presentation. The pathophysiologic changes occurring with different stages of nerve compression must be considered when interpreting diagnostic test results and predicting response to physical therapy management.

What are the Management options available for Carpal Tunnel Syndrome (CTS)? 

Depending upon the patients’ choice and severity, patients with carpal tunnel syndrome can be treated with conservative treatment or surgery. 

Based on the potential side effects and risks of surgery, patients prefer a conservative treatment option like medication, local injection or physical therapy first. 

A conservative treatment program may include the following

  • Medication:  Various researches suggest that non-steroidal anti-inflammatory drugs (NSAID) are not as effective as compared to oral corticosteroids. These drugs are used to treat the pain and inflammation caused by Carpal Tunnel Syndrome. Mediations do not treat the under laying cause of pain.
  • Local steroid injection: Betamethasone and Prednisolone are used as an inject able. Studies have shown pain relief for CTS patients however, local steroid injection is not a definitive treatment option. 
  • Frequent breaks: Whether you're working on desk top/laptop/mobile, playing guitar, writing or typing take a break after every 15 minutes. At the point when it goes off, stop what you're doing and wriggle your fingers, stretch your hands and move your wrists these activities will increase blood flow to these areas.
  • Positioning: Try to keep your wrists in neutral position as much as possible. Any activity which requires your wrists to bend in either direction should be avoided.
  • Splinting: You can use wrist splint to keep your wrists straight. It can help with facilitating the strain on your median nerve. Symptoms are more typical around night time, so wearing a support around evening time could ease your secondary effects before they start.
  • Intermittent exercise:
    1. Median nerve glide where the Median nerve is gently stretched 
    2. Tendon glides which focuses on stretching of the tendons in the carpal tunnel.
    3. Strengthening exercises of wrist.
    4. Ball squeezing exercise to strengthen hand and forearm muscles.
  • Stretching of hand wrist and forearm.
  • Pain-relieving modalities like hot and cold packs/therapeutic Ultras sound: These can be used to relieve pain however, hot and cold pack should be used with extreme precautions as patients with CTS may have loss of sensation.

Conservative treatment may be helpful for patients with mild or moderate CTS. However, if satisfactory results are not gained, or symptoms recur, then possible surgical decompression is inevitable. Surgery is considered when the symptoms are severe because it almost takes 6 - 8 weeks to return to work after the operation.

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  1. Enjoyed reading this article. Unfortunately I have seen a loved endure this and need surgery. She used braces but the pain became unbearable for her.😢 She is now doing better but does deal with arthritis now in hands and it’s very painful for her too. Thanks for sharing this article. 😊

    Pastor Natalie (ExamineThisMoment)

  2. I know a couple of people who deal with this so it was good to read more and better understand what they experience. Thanks for sharing!

  3. I've heard of CPT but I didn't realise how nasty it could get, a very informative post x

    Lucy Mary


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