Carpal Tunnel Syndrome (CTS)

Carpal Tunnel Syndrome (CTS) is a condition caused by compression of the median nerve at the wrist as it passes through a narrow passage called the carpal tunnel. This nerve provides sensation to the thumb, index finger, middle finger and part of the ring finger, and supplies some muscles at the base of the thumb. Compression of the nerve can cause numbness, tingling, pain and, in advanced cases, weakness of the hand. Symptoms may initially occur at night and gradually interfere with daily activities such as writing, driving, holding a phone or gripping objects.

Causes & Risk Factors

• Carpal Tunnel Syndrome develops when pressure on the median nerve increases within the carpal tunnel.
• Repetitive hand movements: Activities involving repeated wrist bending or forceful gripping.
• Inflammation or swelling: Tendon inflammation or fluid retention can increase pressure inside the tunnel.
• Medical conditions: Diabetes, hypothyroidism, rheumatoid arthritis and other conditions associated with nerve damage or swelling.
• Pregnancy: Fluid retention may temporarily increase pressure on the nerve.
• Wrist injuries: Fractures or other injuries that alter the structure of the wrist.
• Other factors: Increasing age, obesity and family history.

Symptoms

• Numbness and tingling: Mainly in the thumb, index finger, middle finger and thumb-side half of the ring finger.
• Night-time symptoms: Numbness, tingling or pain that wakes the patient from sleep.
• Hand or wrist pain: Pain may sometimes radiate toward the forearm.
• Weak grip: Difficulty holding objects, opening jars or performing fine hand movements.
• Dropping objects: Reduced sensation or thumb weakness may cause objects to slip from the hand.

Median Nerve Conduction Study (NCS) & Ultrasound Assessment

Ultrasound-Guided Median Nerve Hydro-Dissection & Injection

How Carpal Tunnel Syndrome (CTS) is Diagnosed?

Clinical examination

1. Tinel's sign: Tapping over the median nerve at the wrist may reproduce tingling in the fingers.
2. Phalen's test: Holding the wrists in a flexed position may reproduce symptoms.

Sensory examination: Assessment of sensation in the fingers.

Motor examination: Assessment of thumb strength and muscle wasting at the base of the thumb.

1. Nerve conduction study (NCS) and Electromyography (EMG): To determine the location and severity of nerve compression.
2. Ultrasound: To demonstrate enlargement of the median nerve and identify certain structural abnormalities around the carpal tunnel.
3. MRI: Generally, not required but may be considered when atypical symptoms or uncertain diagnosis.

Treatment Options for Carpal Tunnel Syndrome (CTS)

Treatment depends on symptom severity, duration, clinical findings and evidence of nerve damage.