Carpal tunnel syndrome (CTS) is one of the most common injuries affecting the hand and wrist, occurring in approximately 3-6% of the general population. So what is CTS and how can it be treated?

What is Carpal Tunnel Syndrome?

The carpal tunnel is a small passageway in the wrist, where the floor and roof is made up of carpal bones and the transverse carpal ligament (a strong band of connective tissue). The median nerve and flexor tendons (surrounded by synovial membrane) pass through the carpal tunnel.

The median nerve provides sensation to the index finger, middle finger, ring finger and thumb. It also supplies some of the flexor tendons that control movement of the hand. CTS occurs when the median nerve gets compressed as it passes through the carpal tunnel.

Individuals with CTS often have pain, numbness, and tingling in the hand as well as loss of grip strength. As a result, it can be difficult holding or gripping objects such as lifting up a coffee cup and writing.

Causes of CTS

There are various factors that can lead to increased compression of the median nerve as it passes through the carpal tunnel.

  • Repetitive hand and wrist movementscan irritate the flexor tendons and synovial membrane surrounding the tendons. The synovial membrane’s function is to help with lubrication and facilitate smooth movement between the flexor tendons. However, these structures can become irritated and inflamed, which can lead to swelling and decreased space in the carpal tunnel.
  • Positioning and ergonomics.Typing on the computer, holding a cell phone, curling up wrist when sleeping and cooking are some activities that can place the wrist/hand at end-range flexion or extension for a prolonged period of time. This can lead to increase pressure on the median nerve. Work station set up and posture during these activities can either help decrease or increase force exerted on the wrist.
  • Medical history. Diabetes, rheumatoid arthritis, thyroid disorders and autoimmune diseases are some medical conditions that can predispose individuals to CTS.
  • Hand or wrist trauma. Fracture to carpal bones or the radius/ulna can is a risk factor for developing CTS.
  • Genetics and Sex. The osseous structures and strong connective tissues that make up the carpal tunnel itself do not allow for much expansion. Slight anatomical differences can lead to decreased space for structures to pass through and possibly, an increase chance of median nerve compression. In addition, it is found that females are 2-3 times more likely to experience CTS than males.
  • Pregnancy. Swelling in the hand/wrist can be caused by hormonal changes during pregnancy. Symptoms can be bilateral or unilateral.

Treatment Options

If you suspect that you may have CTS, please seek advice from a health care professional for treatment options that are right for you.

The first line of defence for CTS is usually conservative management. It usually comprises of treatment methods that are geared towards preventing repetitive and consistent injury to the median nerve.

Some treatment options that your health care professional may advise are:

  • Immobilization of your hand wrist in attempt to reduce the amount of pressure being exerted on the muscles/tendons and nerve.
  • Avoid aggravating activities (i.e. rest) and being more aware of posture and hand positioning.
  • Anti-inflammatory medication to decrease pain, swelling inflammation.
  • Ice for pain relief and prevent swelling.
  •  A physiotherapist can assess, diagnose and treat CTS. They can guide you on the types of exercises (i.e. strengthening, stretching etc.) you can do, what activities you should avoid and provide strategies for pain management. Consistent therapy can provide effective results.

Treatment Options

If conservative management does not work, your health care professional may refer you onto an orthopaedic specialist/surgeon to discuss further options such as surgery.

Sports & Exercise Medicine Institute clinics assist with sports medicine and physiotherapy. Located in St. Claire, Thornhill, Sheppard, and greater Toronto, we provide a myriad of services. These include active release techniques, sports podiatry, and sports massage among others.

Get in touch with our team by calling at 1-844-223-7364 to learn more about our services!

References:

Atroshi I, Gummesson C, Johnsson R, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999; 282 (2): 153-158. 

 Niver GE, Ilyas, AM. Carpal tunnel syndrome after distal radius fracture. Orthop Clin North Am. 2012; 43(4): 521-527.

Olecrud C, Lonnguist L. Acute carpal tunnel syndrome caused by fracture of the scaphoid and 5th metacarpal bones. Injury. 1984; 16(3): 198-199.

Stolp-Smith KA, Pascoe, MK, Ogburn PL. Carpal tunnel syndrome in pregnancy: frequency, severity, and prognosis. Arch Phys Med Rehabil. 1998; 79: 1285-1287.

LeBlanc KE, Cestia W. Carpal tunnel syndrome. American family physician. 83(8): 952-958.