Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a chronic condition that causes wrist pain, hand pain, numbness, and weakness. CTS is related to increased pressure on the median nerve, which provides strength to the wrist and hand, as well as sensation to the fingers.
What is the carpal tunnel?
The carpal tunnel is a tunnel-like wrist structure. The sides and bottom of the tunnel are formed by the carpal (wrist) bones. The top portion of the tunnel is covered by the transverse carpal ligament, which is a strong band of connective tissue. The carpal tunnel protects the flexor tendons and median nerve.
What other structures are affected by CTS?
Carpal tunnel syndrome affects three median nerves, which travels from the forearm into the wrist and hand. This nerve controls sensation of the palm side of the thumb, index finger, and 3rd and 4th fingers. It also controls muscles around the thumb. The flexor tendons bend the thumb and fingers and travel through the tunnel.
How common is carpal tunnel syndrome?
The incidence of CTS in the U.S. is around 2 cases per 1,000 people per year. In high-risk groups, the incidence may rise to as high as 150 per 1,000 subjects per year.
Who gets CTS?
Carpal tunnel syndrome is more common among women than men. Certain risk factors increase the likelihood of developing CTS. Risk factors include:
- Heredity – Having a family member with CTS and having a smaller than normal carpal tunnel.
- Excessive hand/wrist use – Over time, this contributes to CTS.
- Hormones – Pregnancy can contribute to this condition.
- Certain medical conditions – These include diabetes, thyroid disorder, and rheumatoid arthritis.
What causes carpal tunnel syndrome?
CTS occurs when tissues (called the synovium) around the flexor tendons in the wrist swell, causing pressure on the median nerve. The synovium lubricates the tendons, making finger movement easier. Swelling of this tissue will narrow the carpal tunnel, crowding the median nerve.
What are the symptoms of CTS?
The symptoms associated with CTS usually begin gradually and progress over time. Symptoms are often worse at night, when holding something, or when driving. They include:
- Numbness, pain, and tingling in the hand.
- An electric shock sensation in the thumb and long fingers.
- Pain and uncomfortable sensations traveling up the arm and to the shoulder.
- Clumsiness or weakness with fine motor activities, such as buttoning a shirt.
- Muscle wasting at the base of the thumb.
How is CTS diagnosed?
The Chicago pain management doctor will first ask questions about your symptoms and discuss your medical history. In addition, he/she will perform a thorough physical examination to check for wrist strength and numbness/tingling of the fingers. The doctor will order certain tests, including:
- Electrophysiological tests – To assess median nerve and muscle function, electrophysiological tests are done.
- X-rays – To check out the bones and structures of the wrist, the doctor will take x-rays.
How is CTS treated?
When diagnosed early on, carpal tunnel syndrome can be treated without surgery at the top pain clinics in Chicago. However, as the condition progresses, surgery may be required. Treatment options include:
- Bracing or splinting – A brace or splint can be worn at night to keep the wrist in a neutral position. This prevents median nerve irritation that occurs when wrists curl during sleep. In addition, braces can be worn when performing activities that aggravate symptoms.
- Corticosteroid injections – To provide symptomatic relief, the carpal tunnel can be injected with a corticosteroid agent. The steroid decreases connective tissue swelling, which alleviates pressure on the median nerve. In a large systematic review, researchers found that injections offer relief that lasted for up to 3 months. Based on a recent study, injections have around a 75% success rate.
- Physical therapy – This involves use of heat therapy, ultrasound, and electrical stimulation to alleviate pain. In addition, the therapist uses strengthening and flexibility exercise to improve wrist range of motion and function.
- Surgery – For severe cases of CTS, surgery is used. During the procedure, the ligament is cut to make room for the tendons and median nerve. This surgery is performed outpatient under local anesthesia. The surgeon can perform the procedure via the endoscopic method, which involves making small incisions and uses a camera and small tools to make necessary repairs. In a study of 47 patients who underwent carpal tunnel release surgery, 88% had significant reduction in the symptom severity score.
What can I expect during recovery after surgery?
After surgery, you need to elevate your hand to reduce swelling and prevent stiffness. Expect minor soreness of the palm for a few weeks, and weakness of the grip and pinch may last up to 6 months. Complete recovery can take up to 12 months.
Premier Pain & Spine in Chicago offers top nonoperative carpal tunnel treatment. There are several pain centers in the Chicago metro area, with most insurance being accepted. Call us today!