Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome (CTS) is caused by irritation of the median nerve, which enters the hand through a narrow channel called the carpal tunnel. This passageway is located in the wrist, between the ball of the thumb and little finger. There are many causes of carpal tunnel syndrome (which usually occurs in the "working hand"), including rheumatoid arthritis, infections, tumours, trauma, pregnancy, diabetes, and excessive repetitive movements of the hand and wrist. Carpal tunnel syndrome is much more common in women than in men, and it usually occurs in persons between the ages of 40 and 60. Patients with carpal tunnel syndrome initially feel tingling or pain in the area of the thumb, index finger and middle finger. The symptoms occur mainly at night. Shaking the hand provides temporary relief. As the disease progresses, atrophy (wasting) of the muscles in the region of the ball of the thumb can occur.

Diagnosis

First, the doctor will perform clinical function tests to assess the range of motion, strength and sensibility (sensations perceived on the skin) of the affected hand compared to the healthy hand. An X-ray should be obtained, particularly if there is a history of wrist fracture, in order to rule out compression of the carpal tunnel due to narrowing of bony structures. If the cause remains unclear, you may be referred to a neurologist for a nerve conduction velocity test.

Electromyography (EMG) is also very useful in these cases. The EMG test measures the electrical activity of muscles supplied by the median nerve. By analysing the EMG recordings, the neurologist can precisely determine whether the cause of CTS is nerve or muscle-related. In addition, the exact site of nerve or muscle damage can be identified. As we have the equipment on hand, we can perform the test on site immediately. This can save you a trip to another specialist.

Treatment:

Conservative treatment can be performed if the condition is diagnosed early or if the symptoms are not severe. Conservative treatment includes immobilisation of the hand in a splint. The splint keeps the hand in a slightly hyperextended position and is worn mainly at night. Local injection of long-acting cortisone is another option. Cortisone reduces inflammation.
If all conservative measures fail to relieve the symptoms, surgical treatment under local anaesthesia may be considered. Surgical access is obtained through a small skin incision made on the palm or wrist. The ligament forming the roof of the carpal tunnel is then cut to surgically enlarge the carpal tunnel. This results in decompression of the nerve and stops the irritation.