Carpal tunnel syndrome (CTS) is a painful condition in the wrist and hands involving the compression of a main nerve and tendons that bend the thumb, index finger, middle finger, and ring finger.
The carpal tunnel, a narrow passageway about the width of the thumb, is located on the palm side of the wrist. It protects the median nerve and nine tendons, which control sensations and movement in the thumb and first three fingers. CTS happens when the nerve gets compressed and can be caused by several conditions including: bone spurs, swelling/thickening of the lining and lubricating layer (synovium) of the tendons in the carpal tunnel, hormonal disorders (diabetes, thyroid conditions), fluid retention, amyloid (an abnormal protein produced in the bone marrow), repetitive motions (either forceful or prolonged), injury to the wrist, generalized nerve problems, or simply a narrower than average carpal tunnel.
Symptoms usually start gradually, the first sign commonly being a vague aching in the wrist which can extend down to the fingers and up as far as the elbow. Other common symptoms include tingling or numbness in the fingers, weakening of grip strength or a tendency to drop objects, constant loss of feeling in the fingers, and pain radiating from the wrist up the arm and down to the palm and fingers.
Women are three times more likely than men to develop carpal tunnel syndrome. Women tend to be more susceptible to carpal tunnel syndrome after menopause or while pregnant, while men tend to be more susceptible during middle age. CTS can be caused by genetics, such as through the shape of the wrist or size of the carpal tunnel. The risk factor for CTS is also increased by certain health conditions including rheumatoid arthritis, thyroid problems, and diabetes. People who smoke generally experience more severe symptoms and a longer recovery time.
Milder symptoms can be relieved by taking fairly frequent breaks to rest the hands and applying cold packs to reduce swelling. Most people, however, need more than rest and cold packs to control the syndrome. Common nonsurgical therapies include putting a splint on the wrist at night, taking nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain (if inflammation is the cause of the CTS), or having a corticosteroid (like cortisone) injected into the carpal tunnel. Oral corticosteroids are not as effective as injections when treating CTS.
Surgery is also an option when treating CTS. There are several different techniques of surgery for this condition, but all of them involve cutting the ligament that presses on the median nerve. The surgery may be done with an endoscope, a telescope-like device with a camera on the end which allows the surgeon to perform the operation through small incisions in the hand or wrist, though the surgery is usually performed by making an incision in the palm of the hand and cutting through the carpal nerve (which is the nerve that compresses the median nerve) to relieve the pressure on the median nerve.