Carpal Tunnel Syndrome Signs, Symptoms and Management (CTS)

Carpal tunnel syndrome signs is one of the commonest entrapment neuropathies seen in clinical practice. Entrapment neuropathy is a condition where a nerve of the body is subjected to unusual compression at a certain anatomical location, resulting in symptoms due to the compression.

Carpal tunnel is located at the wrist. This is a tunnel surrounded by wrist bones from below and a thick fibrous band called “flexor retinaculum” on top. A nerve called Median nerve passes through the tunnel and supply small muscles of the hand and carries sensory impulses from skin of the outer aspect of the palm and the outer most three fingers.

Carpal Tunnel Syndrome Signs are mostly seen without any obvious cause. The tunnel might be getting smaller with aging resulting in compression of the nerve. In certain conditions and diseases carpal tunnel syndrome may be a presenting problem.

Pregnancy, trauma to the wrist, diabetes, rheumatoid arthritis, and hypothyroidism are some of the conditions which may give rise to carpal tunnel syndrome.

Carpal Tunnel Syndrome Signs,Symptoms

Carpal Tunnel Syndrome Signs commonly affects the middle age, obese females. Patients present with numbness or tingling sensation of the fingers and hand. Some may experience pain. These symptoms tend to get worse at night. Keeping the wrist flexed for a longer duration will reproduce the symptoms (reading a book, cutting with a scissor etc.) Patients with long duration symptoms might present with wasting of muscles at the thenar eminence.

Tapping on the palmar side of the wrist may reproduce symptoms. This is called the Tinel’s sign.

Carpal Tunnel Syndrome Signs, Diagnosis

Once the condition is suspected it is important to look for the secondary causes mentioned above.

The diagnosis is made by a special test called Nerve conduction test. This is a non-invasive test which will confirm that the median nerve impulse conduction is slow at the carpal tunnel area. The test can also grade the severity of the condition.

Carpal Tunnel Syndrome, Management

Correcting a secondary cause is important in the overall management of the patient. For example treating Hypothyroidism may lead to symptom improvement. During pregnancy patients are managed mainly non-surgically since the symptoms tend to resolve after the delivery.

Splinting the wrist and elevation of the hand especially at night may reduce Carpal Tunnel Syndrome Signs

Pain medication and drugs like Gabapentin may reduce the nerve compression symptoms

The definitive treatment for the condition is by surgery.

“Carpal Tunnel Syndrome Signs” surgery is a day case one, which can be done under local anaesthesia or under general anaesthesia. A tourniquet is used to create a bloodless field. The surgeon will make an incision over the wrist and will work downward to identify the flexor retinaculum- the thick fibrous band forming the roof of the carpal tunnel. Taking precautions to protect the median nerve the fibrous band is completely divided to decompress the carpal tunnel.

During the post-operative period it is important to exercise (especially wrist exercises) the hand till the sutures comes out. This will prevent recurrence of the condition by re stenosis of the carpal tunnel during healing.

Dr Udaya Samarajeewa MBBS, MD- Surgery, MRCS (Eng.)

Consultant General Surgeon