What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is the most common compression neuropathy, or “pinched nerve,” in the arm. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Symptoms such as numbness, tingling, hand weakness, and pain can result if the nerve is compressed or “pinched.”

The word “carpus” is derived from the Greek word karpos, which means “wrist.” The carpal tunnel is a passageway in the wrist through which the median nerve and tendons of the hand travel. The carpal tunnel is a narrow, confined space: the floor of the tunnel is made up by the carpal bones of the wrist, and the roof is created by the transverse carpal ligament. The median nerve is at risk for compression within this tunnel. If there is abnormal swelling, altered wrist anatomy, or injury to this area, the function of the median nerve may be affected.

What causes carpal tunnel syndrome?

In most cases, the cause of CTS is unknown. Thyroid disorders, rheumatoid arthritis, pregnancy, vitamin deficiencies, diabetes, fluid retention, and trauma can be associated with CTS. Women are more commonly affected than men. Repetitive, heavy/forceful gripping and heavy use of vibratory tools may increase a person’s risk of CTS.

How do I know if I have carpal tunnel syndrome?

Patients with CTS commonly report “numbness” or “tingling” in the fingers. Some patients feel that the fingertips are “asleep” or report “poor circulation” in the hands. Symptoms are often worse at night and people tend to shake their hands for relief. Some patients report increased symptoms while gripping a steering wheel. Dropping objects, clumsiness with the hands, or a weak grip are also common complaints. Some people also report pain in the forearm, wrist or fingers. In severe cases, the muscles at the base of the thumb (thenar muscles) can become weak and atrophy, sometimes permanently. Please call Raleigh Hand Center if you would like to be evaluated for possible carpal tunnel syndrome.

Often the diagnosis can be made on the basis of your symptoms, medical history, and physical examination. An electrodiagnostic study (nerve conduction study and/or electromyogram EMG) can be ordered to confirm the diagnosis.

What are the treatment options?

Not everyone with carpal tunnel syndrome needs surgery. Many people with CTS improve with non-operative treatment. Wearing a wrist brace at night supports the wrist in neutral alignment and takes pressure off the median nerve. Avoiding prolonged wrist flexion and forceful or repetitive gripping may also help. Corticosteroid injections provide an anti-inflammatory effect and can be effective in many patients.

Should these measures fail to improve the condition, or if nerve compression is severe, surgery may be recommended. A carpal tunnel release (CTR) surgery is performed to decrease pressure on the median nerve. During this procedure, the “roof” of the carpal tunnel (the transverse carpal ligament) is divided. Cutting the transverse carpal ligament increases the size of the carpal tunnel and provides more room for the median nerve.

The length and type of incision varies among surgeons; however, the common goal is to reduce pressure on the median nerve. The length of incision used for CTR has decreased in size since the procedure was invented decades ago due to advancement in surgical techniques. Carpal tunnel release surgery can be performed using smaller incisions these days. Open CTR and endoscopic CTR are two surgical options. The recommended procedure will be discussed with you in the clinic.