What is carpal tunnel syndrome (CTS)?

From the Guidelines

Carpal tunnel syndrome is a condition that occurs when the median nerve, which runs from your forearm into your hand, becomes compressed at the wrist, and the most effective way to diagnose it is through a combination of clinical evaluation and electrophysiologic studies, with ultrasound (US) being a highly sensitive and specific diagnostic tool, as demonstrated in recent studies 1. The median nerve passes through a narrow passage called the carpal tunnel, and when this area becomes inflamed or swollen, it puts pressure on the nerve, causing symptoms such as numbness, tingling, or pain in the thumb, index, middle, and part of the ring finger. These symptoms often start gradually, may be worse at night, and can be triggered by activities like driving or holding a phone. To manage mild symptoms, you can try:

• Wrist splints (especially at night)
• Over-the-counter pain relievers like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily)
• Taking regular breaks from repetitive hand activities
• Applying ice for 10-15 minutes several times daily to reduce inflammation If symptoms persist or worsen, it is essential to see a doctor, as more severe cases may require prescription medications, steroid injections, or surgery to release the pressure on the nerve, with surgical treatment being shown to relieve symptoms significantly better than non-surgical treatment, although it is associated with more complications 1. The condition often develops due to repetitive hand movements, wrist positioning during sleep, or conditions like diabetes or rheumatoid arthritis that increase susceptibility to nerve compression. In some cases, further imaging may be necessary, but ultrasound (US) or MRI without contrast may be appropriate in selected circumstances, as they can provide valuable information for diagnosis and management, as stated in recent guidelines 1.

From the Research

What is Carpal Tunnel Syndrome

• Carpal tunnel syndrome (CTS) is a common medical condition that occurs when the median nerve is squeezed or compressed as it travels through the wrist 2.
• CTS is characterized by pain in the hand, numbness, and tingling in the distribution of the median nerve 2, 3.
• The syndrome can cause pain, weakness, sensory loss, and activity limitations in the wrist and hand 4, 5.

Risk Factors and Diagnosis

• Risk factors for CTS include obesity, monotonous wrist activity, pregnancy, genetic heredity, and rheumatoid inflammation 2.
• The diagnosis of CTS is conducted through medical assessments and electrophysiological testing, although idiopathic CTS is the most typical method of diagnosis for patients suffering from these symptoms 2.
• Provocative maneuvers, such as the Phalen test and Tinel sign, have varying sensitivity and specificity for the diagnosis of CTS 3.

Treatment Options

• Doctors use both non-surgical and surgical treatments when addressing CTS 2.
• Non-surgical treatments include wrist splinting, change of working position, medications, and the use of alternative non-vibrating equipment at work 2, 6.
• Surgical methods include open release and endoscopic surgeries 2, 3.
• Splinting the wrist using an orthosis is usually offered to people with mild-to-moderate findings, but its effectiveness remains unclear 6.

Effectiveness of Splinting

• Splinting may provide little or no benefits in symptoms in the short term (< 3 months) 6.
• Night-time splinting may result in a higher rate of overall improvement in the short term 6.
• It is unclear if a splint is optimally worn full time or at night-time only and whether long-term use is better than short-term use 6.