Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome (CTS) is a condition in which the median nerve that runs along the forearm to the hand becomes compressed at the wrist. This pressure causes numbness, tingling, weakness, and sometimes pain in the thumb, index and middle fingers. Early symptoms can start out mild but worsen over time if not treated. CTS can be treated nonsurgically using behavior and environment changes, splints, and injections, but surgery may be necessary for lasting relief.

What Causes Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is one of the most common hand and wrist conditions, especially for people who perform repetitive tasks. While the cause is often unknown, it can be caused by:

• Arthritis
• Wrist injuries or swelling
• Health conditions like diabetes, arthritis, hypothyroidism, and amyloidosis
• Pregnancy-related fluid retention

What Are the Symptoms?

• Numbness or tingling in the thumb and fingers, except the small finger
• Weakness in the hand
• Pain or burning that travels up the arm
• Symptoms often worsen at night
• Tendency to drop objects

How Is Carpal Tunnel Syndrome Diagnosed?

An orthopedic specialist can provide a diagnosis using:

• A physical exam to test sensation and strength
• A review of your symptoms and medical history, including any injuries
• Diagnostic tests, including nerve conduction studies (EMG)

How Is Carpal Tunnel Syndrome Treated?

Treatment depends on severity. Many cases improve with nonsurgical treatments, especially with improvements to ergonomics.

Nonsurgical Treatments

• Wrist splinting, especially at night
• Activity changes or ergonomic adjustments
• Anti-inflammatory medications
• Cortisone injections to reduce swelling
• Physical or occupational therapy

Surgical Treatments

If symptoms persist or worsen despite conservative care, surgery may be necessary.

• Carpal tunnel release: This surgery involves cutting the ligament that is pressing on the median nerve to relieve pressure. The surgery can be performed in various ways, but all involve completely cutting the ligament pressing on the nerve.

What Are the Risks?

Like any surgery, CTS surgery carries some risk of complications, including:

• Infection
• Incomplete relief of symptoms
• Scar tenderness or stiffness
• Nerve damage (in rare cases)

What Is Recovery Like?

Most people return to light activity such as driving and typing immediately, but full recovery may take 3-4 months. The area of the incisions can be tender for 4 months. Hand therapy may be needed to restore strength and flexibility.

What Is the Outlook for Carpal Tunnel Surgery?

Most patients experience significant improvement, especially when surgery is performed before permanent nerve damage occurs.