Carpel Tunnel Syndrome is a disorder of “Median Nerve” compression when it passes through the anatomical carpel tunnel to supply the thumb, index finger and the middle fingers of the hand. Carpel tunnel is a tight space at the wrist between the wrist bones and the band of fibrous tissue supporting the wrist joint. Any condition leading to inflammation within this space may lead to Carpel Tunnel Syndrome.
Carpel Tunnel syndrome is more common in females between the ages 30 to 50 years. Being less common in developing countries the incidence in the developed countries is somewhat similar and is 1-3 in 1000 per year. With the increase in technology and use of keyboards leading to inflammation at the wrist, the incidence of carpel tunnel syndrome is not only increasing worldwide but also in Pakistan.
The risk factors and causes CTS, let’s have a look at the major causes;
1.Repititive movement of the wrist joint e.g. typing on the keyboard, flattening bread with rolling pin etc.
2.Anantomical factors include wrist fractures or dislocations, arthritis.
3. Chronic illnesses leading to nerve damage like diabetes.
4. Obesity, Menopause and pregnancy.
5. Certain diseases like renal failure, thyroid disorders, and Rheumatoid arthritis etc.
Although these are some of the major causes yet most of the cases of CTS are idiopathic.
Women at greater risk
Anatomically women have smaller bones and spaces, hence carpel tunnel , which is already a tight space at the wrist is much smaller in women as compared to men leading to increase chances of median nerve compression. Moreover during pregnancy women may suffer from pregnancy- induced edema in the Carpel tunnel leading to CTS.
Signs and symptoms
Prompt history plays a major role in diagnosing CTS clinically, hence following are the common signs and symptoms of CTS;
Pain in the wrist and nerve distribution areas including the thumb, index and middle fingers is a common finding. Moreover when it is a part of other musculoskeletal disorders, pain me extend up to forearm and elbow.
Numbness & tingling
Numbness and tingling sensation is one of the most common complaints of patients suffering from CTS. Sleeping of the hand affecting the grip and leading to dropping of the objects is a part of numbness. More over symptoms intensify at night and may lead to wakening up of the patients due to numbness of the hand and electrical, tingling kind of sensations of the first four fingers of hand.
Carpel tunnel syndrome is diagnosed with a combination of prompt history, physical examination and few specific investigations.
Physical examination includes certain tests like “Hoffman Tinel Sign” or “Phalen sign”. No single clinical test exists to make diagnosis of CTS and although these to signs are usually used yet have a very sensitivity and specificity. “Carpel Compression test” has a better sensitivity and specify and can be used to make diagnosis.
First line of investigations include;
*Nerve conduction studies (NCS)
These two investigations not only diagnose CTS but also give an estimation of the severity of the disease.
The following are the treatment options for CTS available;
Rehabilitation and occupational therapy:
Physiotherapy, Therapeutic Ultrasound and short wave diathermy has been helpful in giving short term relief to the patients suffering from mild to moderate CTS. Moreover use of wrist splint (especially at night) for 3-4 weeks has given promising results in doing away with the symptoms.
Use of anti-inflammatory drugs and analgesics like NSAIDS help in giving symptomatic relief. Anti-convulsant drugs like gabapentin or pregabalin can also be used off label in CTS. Corticosteroid injections give long-term benefits when conservative management fails.
Surgical procedure to release compressed median nerve is indicated when conservative and medical treatment fails but is not commonly used in case of CTS.