Carpal Tunnel Syndrome (CTS)
Carpal Tunnel Syndrome (CTS) is a well known medical condition given by compression of the median nerve inside the carpal tunnel.
The carpal tunnel is located on the palmar side of the wrist and is the passageway connecting the forearm to the middle compartment of the deep plane of the palm. The tunnel has bony floor and walls, its roof is a thick sheath of connective tissue, the so called transverse ligament or flexor retinaculum: the nine tendons of the flexor muscles for the fingers and the median nerve pass through it. Movements in the wrist affect the shape and width of the carpal tunnel: both wrist flexion and extension can result in decreasing the cross section of the tunnel.
- Conditions that modify the bony architecture (e.g. rheumatic diseases such as rheumatoid arthritis or wrist fractures) and therefore resulting in narrowing of the carpal passageway can often lead to the onset of the syndrome.
- Conditions that cause an increase of its content (e.g. hormonal changes resulting in swelling of the nerve, due to oedema) are also correlated with the occurrence of carpal tunnel syndrome.
Symptoms of Carpal Tunnel Syndrome
Carpal Tunnel Syndrome mostly affects ladies, generally presenting its onset during the menopause; it is anyway likely that the patients had already experienced the same kind of symptoms during the pregnancies, although they were relieved after delivery or at the end of lactation
Symptoms of Carpal Tunnel Syndrome are:
- Numbness along the thumb, index and middle finger, mostly occurring at night or after repetitive work.
- Numbness is often associated with pain in the same territory and radiating along the upper arm, often even up to the shoulder.
- Pain and numbness can become so intense that patients are often sleepless through the night, uselessly trying to find relief. In the morning they often complain about swollen and stiff hands.
- In the majority of cases, symptoms can affect both hands, with prevalence on one side.
These symptoms are often seasonal: their onset is generally at the beginning of the cold season, pain and numbness tend to decrease when spring arrives, to completely disappear during summer.
Long standing carpal tunnel syndrome may lead to nerve damage that results in:
- constant numbness and sensory loss along the thumb, index and middle finger, so that the patient experiences difficulties in activities such as sewing (they are not able to perceive the needle between the distal ends of the thumb and the other two fingers) or zipping and buttoning up.
- Weakness and progressive loss of thenar muscles (the muscles located on the palmar side under the thumb) which impairs some movements of the thumb
Occasionally the patient experienced the pain and numbness before and then the muscle atrophy develops in absence of these symptoms even several years later.
Carpal tunnel syndrome can be cured.
- In mild cases, conservative treatment (e.g. oral medication that reduce the nerve swelling) may be tried although recurrence of symptoms is likely.
Surgery is the definitive solution and consists in relieving the compression on the median nerve cutting the transverse ligament. The procedure is carried under local anesthesia, simply injecting a few cc of anesthetic on the area of the carpal tunnel: the transverse ligament can then be cut through a small skin incision.
Surgery generally allows relief of pain and numbness
- Long standing muscle atrophy often persist even after surgery
- Rheumatic diseases
- Wrist fractures
- Hemodialysis, with direct correlation between its incidence and the length of the time the patient has received it: carpal tunnel syndrome seems to be found 4 times as often in patients who dialyzed for longer than 5 years in comparison with its incidence in the population who had received hemodialysis for shorter periods.
- Manual works: heavy manual work, work with vibrating tools or even light, repetitive tasks are often predisposing conditions to the development of a carpal tunnel syndrome.
At the Neuro Spinal Hospital expert medical assessment and treatment are provided.
Once it is diagnosed and correctly treated Carpal Tunnel Syndrome offers a good prognosis, with relief of symptoms. As a general rule, the earlier the condition is diagnosed and treated, the better the outcome for the patient.