Dr. Jonathan Y. Lee, a leading Singapore Hand Surgery and Orthopedic upper limb Specialist, discusses Carpal Tunnel Syndrome, a common cause of pain and numbness of the hands and fingers.
What is Carpal Tunnel Syndrome? A Brief Description.
Carpal Tunnel Syndrome (CTS) is one of the leading causes of hand and finger numbness and pain.
Carpal Tunnel Syndrome is most commonly caused by compression of the median nerve at the wrist secondary to tenosynovitis or inflammation of the flexor tendons as they travel together with the nerve through the carpal canal of the wrist.
Carpal Tunnel Syndrome
Classic symptoms include the sensation of ‘pins and needles’, tingling or numbness at the fingertips, particularly at the thumb, index, and middle fingers. There may be associated tightness or pain at the wrist area. In severe cases, patients may have more pronounced numbness (decreased sensation) and pain, weakness of the hand, a feeling of ‘clumsiness’ handling small objects like buttons and dropping objects, changes in hand writing and wrist pain.
Symptoms are often worse during the night and after repetitive activities like typing, gripping tools, driving, reading the newspaper, holding the telephone receiver and using chopsticks. Night symptoms can disturb the patient’s sleep.
Other conditions associated with Carpal Tunnel Syndrome include a tumour in the carpal tunnel canal, diabetes mellitus, hypothyroidism, menopause, pregnancy, renal failure, Raynaud’s Disease, Repetitive Strain Injuries and Double Crush Syndrome. These conditions cause carpal tunnel syndrome by similarly increasing the pressure within the carpal tunnel at the wrist and compressing the median nerve.
An accurate medical history and clinical examination are usually sufficient to make the diagnosis. X-rays may be considered if a bone problem is thought to be a possible cause. Nerve conduction studies, either alone or with electromyography (EMG), may be necessary in severe cases or when there is suspicion that that more than one area of the nerve is being compressed.
Non-surgical treatment (sometimes called Conservative treatment) usually involves taking anti-inflammatory medication, nerve vitamins, splinting and physiotherapy. [read more about this in our next post].
When non-surgical treatments are unsuccessful, in cases of symptom recurrence, and in symptomatically severe cases, surgical treatment may be necessary. There are several surgical options available – the traditional open carpal tunnel release, and the (minimally invasive) endoscopic carpal tunnel release.