What to know about Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) is a peripheral nerve entrapment which involves the Median nerve.
Presentation
Typically individuals with Carpal Tunnel Syndrome experience pain, numbness and/or tingling in the palmar aspect of their thumb, first and second digits (pointer finger and middle finger), and half of the fourth digit (ring finger). A feeling of clumsiness of the hand, especially when gripping, is also a common symptom. These symptoms are worse at night and may be relieved by the individual shaking and moving their hand around.
Cause
The most common cause of Carpal Tunnel Syndrome involves direct external pressure from prolonged wrist flexion or extension and/or repetitive wrist use. This causes pressure on the tunnel in the wrist which the Median nerve travels through. This tunnel is composed of the Transverse Carpal Ligament and the Carpal (wrist) bones. Activities that may cause this external pressure include work which involves intense manual exertion such as hammering, meatpacking, automobile assembly as well as work involving hand and wrist vibration. Other causes of Carpal Tunnel Syndrome involve direct pressure from ganglions, fractures, and dislocations. Pregnancy, rheumatoid arthritis, diabetes, connective tissue disorders, and vitamin B deficiency can also include one’s likelihood of developing Carpal Tunnel Syndrome.
How We Can Help
If you are ever concerned you may have CTS it is advisable to consult with a healthcare professional for evaluation and management. For CTS specifically, effective care includes rehabilitative exercises focused on mobilizing and strengthening the region, manual therapy focusing on myofascial tissues and the surrounding musculature, joint mobilization, and potentially the recommendation of wearing wrist supports/splints.
References: SOUZA, T. A. (2018). Differential diagnosis and management for the chiropractor. Place of publication not identified, MA: JONES & BARTLETT LEARNING.
Frequently Asked Questions
Common questions about carpal tunnel syndrome.
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed as it travels through the carpal tunnel, a narrow passageway on the palm side of the wrist about the size of a dime. It is the most common focal nerve compression, or entrapment neuropathy, and produces pain, numbness, tingling, and weakness in the hand and wrist. Estimates of how common it is in the general population range from about 1% to 5%.
What does carpal tunnel syndrome feel like?
Carpal tunnel syndrome usually causes numbness, tingling, and pain in the thumb, index, and middle fingers and the thumb-side half of the ring finger. Many people first notice symptoms at night, and pain or tingling may wake them up. Symptoms are often intermittent and linked to activities like driving, reading, or typing. As pressure on the nerve continues, hand weakness, clumsiness, poor fine-motor coordination, and eventual wasting of the muscles at the base of the thumb can develop.
What causes carpal tunnel syndrome, and who is most at risk?
Carpal tunnel syndrome is caused by extra pressure on the median nerve within the wrist. Extreme wrist positions and repeated, forceful, or vibrating hand use can contribute, as can wrist injuries, arthritis, and ganglion cysts. It is more common in women, with roughly a 3-to-1 female-to-male ratio, and typically appears in adults aged 40 to 60. Obesity roughly doubles the risk, and pregnancy, diabetes, rheumatoid arthritis, and hypothyroidism also raise the likelihood.
Does carpal tunnel syndrome go away, or does it get worse over time?
Carpal tunnel syndrome typically progresses over time and, left untreated, has the potential to cause permanent nerve damage. That said, most mild-to-moderate cases respond to non-surgical care; approximately 70% to 90% of mild-to-moderate cases respond positively to conservative management. With nonsurgical treatment, relief may take a few weeks or longer. Some recurrence can occur even after surgery, in up to one-third of patients within five years.
How is carpal tunnel syndrome treated without surgery?
Wrist splints are usually the first choice for carpal tunnel syndrome and are typically worn at night to keep the wrist in a neutral position, which lowers pressure in the tunnel. Care may also include physical therapy with stretching, strengthening, and nerve-gliding exercises, ergonomic changes to the workstation, activity modification, and over-the-counter medications. A steroid injection is a viable first-line alternative to night splinting, with relief that typically lasts about 3 months.
When is surgery needed for carpal tunnel syndrome, and how well does it work?
Surgery for carpal tunnel syndrome, called carpal tunnel release, is generally considered for people who do not respond to conservative treatment or who have severe CTS confirmed by electrophysiological (nerve) testing. It relieves pressure by cutting the ligament that forms the roof of the tunnel and is usually an outpatient procedure. Initial success rates surpass 90%, though long-term results are somewhat less promising, with an approximate success rate of 60% at the 5-year mark.
How can I lower my risk of carpal tunnel syndrome?
To lower the risk of carpal tunnel syndrome, general guidance is to avoid bending the wrists for long periods and keep them in a straight or neutral position, and to limit prolonged or repetitive wrist flexing. Taking frequent breaks, doing occasional hand and wrist stretches, and aligning a keyboard to avoid a bent-wrist posture can help. Staying physically active and keeping a healthy weight are also advised. These measures reduce risk but cannot guarantee prevention.
When should I see a clinician about hand or wrist numbness?
Carpal tunnel syndrome tends to worsen over time and can cause lasting nerve damage if untreated, so it is reasonable to see a healthcare provider soon after noticing tingling, pain, or numbness in the wrist, hand, or fingers. Warning signs of more advanced compression include constant numbness, hand weakness, and visible wasting of the muscle at the base of the thumb. An accurate diagnosis matters because other conditions can mimic carpal tunnel syndrome.
The information on this website is general education about musculoskeletal and movement-related conditions. It is not medical advice or a diagnosis, and it cannot tell you what is causing your symptoms. Reading it is not a substitute for an in-person evaluation, and booking a visit does not confirm that your condition is right for our care until a provider has examined you. This information cannot identify every condition, and some urgent problems can feel like musculoskeletal pain. If your symptoms are severe or getting worse, or you are unsure how urgent they are, contact your physician, call 911, or go to the nearest emergency room. When in doubt, seek emergency care.
