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Carpal Tunnel Syndrome (CTS) is a group of symptoms and signs caused by entrapment or pinching of the median nerve at the wrist, where is passes through an enclosed space called the carpal tunnel, just under a ligament called the retinaculum flexorum. Typically, pinching and irritation of the nerve may cause several symptoms .

Over 4/5th of patients with CTS report tingling or numbness of the hand which may be intermittent or continuous. It most often starts in the tip of the middle finger, but sometimes involves the thumb and index finger as well, or even extends to the whole hand and up the arm.

Pain may also be present over the wrist, palm or forearm, sometimes extending up to the shoulder. There may be episodic electric like sensations over the palm or wrist with certain wrist or hand movements.

Pain and tingling are frequently worse at night, often waking the person, and tend to be worse after the hand

has been used a lot in grasping. They tend to be partially relieved by moving the hand about, shaking it or hanging it over the side of the bed.

Wasting and weakness may occur in the muscles of the thenar eminence (the fleshy part of the palm below the thumb), supplied by the nerve, but usually only after several years.

CTS occurs more commonly in women than men and more frequently in the 50's and 60's, but may occur in younger people as well. Most frequently, it involves the dominant hand as an isolated problem, with higher incidences in those requiring considerable use of the hands occupationally.

Symptoms may appear during pregnancy and resolve after delivery, and very rarely can be familial (i.e.; inherited as a family tendency).

CTS may also occur as a complication of other medical problems such as polyneuropathies (a general disease of the peripheral nerves), acromegaly (a growth hormone disturbance), thyroid disease, Rheumatoid arthritis, Systemic Lupus erythematosis ("Lupus") and other inflammatory conditions. It may occur in conjunction with tendinitis.

The numbness and tingling are caused by a disruption in the normal way the nerve transmits sensation from the hand, often due to loss or thinning of the specialized insulating cells that cover the nerve fibre.

There are many reported treatments for CTS, some of little value. The treatments that have been documented to work in a majority of people include: 

-Splinting of the wrist to support it, especially at night where it may relieve the nocturnal symptoms.

-Anti-inflammatory drugs or local cortisone injection, especially if pain is a prominent symptom.

-Surgical decompression of the nerve when the symptoms are severe and unrelieved by more conservative measures.

Rest and splinting of the wrist are frequently used to treat CTS. Different surgical techniques are available and vary from surgeon to surgeon.

Usually, the symptoms of CTS are fairly characteristic, but occasionally they are not typical and can be mimicked by other problems.

It is often difficult to differentiate the pain of tendinitis from the pain of CTS, especially when they occur together.

Tingling and numbness similar to that caused by CTS can also occur with compression of the nerve higher up

where the nerve rootlet exits the spine. More rarely the nerve can be compressed in the forearm.

Electrophysiological testing (EMG) is useful in difficult cases to help confirm the diagnosis and is also usually done if surgery is being considered. It does not, however, by itself necessarily exclude the presence of other concurrent problems, and must be interpreted in light of the physical examination.

This data is provided for informational purposes only. It does not substitute for individualized advice from a qualified physician. Although attempts have been made to ensure the material is accurate and up to date it is provided in an 'as is' state. Neither the author nor Neurology BC assumes any liability for errors or omissions or any problems that might arise due to them. Always consult your physician or qualified health professional before acting on information that concerns your health.