Orthopedic surgeons from the Joint Replacement Centers at Shady Grove Adventist and Washington Adventist Hospitals answer common questions about carpal tunnel syndrome
Q. What is carpal tunnel syndrome?
A. LORNE WEEKS, MD: The carpal tunnel is a canal in the wrist through which the median nerve and nine flexor tendons pass. The median nerve runs from the forearm into the palm and controls sensation to the thumb and index, middle and ring fingers. Flexor tendons control joint movement in the hands. Carpal tunnel syndrome, or CTS, results from a compression of the median nerve at the base of the palm.
Q. What are the symptoms of CTS?
A. STEVEN TUCK, MD: The most common initial symptoms of CTS include nighttime pain with numbness involving the thumb, index and middle fingers and sometimes the ring finger. With time, numbness and tingling occur with use in the same four fingers—especially with gripping or squeezing such as when driving as well as when holding a book, a newspaper or a phone. Usually symptoms do not appear in the pinky finger. Pain will occur in the hand and fingers and radiate up the arm into the forearm and elbow as the problem worsens.
Q. How does CTS develop?
A. DR. WEEKS: Predisposing factors for carpal tunnel syndrome include diabetes, hypothyroidism, gout, rheumatoid arthritis, pregnancy, obesity and heavy manual work frequently involving vibrating tools. Swelling of the nine flexor tendons within the carpal tunnel leads to compression of the median nerve.
Q. What are the risk factors for CTS?
A. DR. TUCK: There are complex causes of carpal tunnel syndrome. Internal risk factors include variations in the structure and function of one’s wrist. External factors include repetitive motion, forceful use of the hand, vibration and the position of the hand during use.
Q. How can I reduce my risk for CTS?
A. DR. WEEKS: Most patients sleep in a fetal position with wrists flexed, which compresses the median nerve at the level of the carpal tunnel. Wearing a splint keeps the wrists extended and may prevent the development of carpal tunnel syndrome during sleep. Avoiding certain positions at night, such as sleeping on a side, helps reduce risk as well.
Q. What treatment options are available?
A. DR. TUCK: Conservative measures include nighttime splinting, oral anti-inflammatories, occupational therapy and steroid injections. If pain and numbness continue or if studies demonstrate an interruption in the median nerve conduction, the patient may need surgery. This may include division of the carpal tunnel ligament through a small incision in the palm, which can be done either under direct vision or with a small telescopic-like device.