Carpal Tunnel Syndrome (CTS)

What is Carpal Tunnel Syndrome?
  • Carpal Tunnel Syndrome (CTS) is the compression of the median nerve within a canal created at the wrist by the carpal bones bordering the bottom of the canal and a thick, fibrous ligament laying over the top. 
  • The median nerve is one of the three main nerves that provide power and sensation to the arm.
  • The median nerve is the "power cord" that travels from the neck to the fingers, supplying sensation to the thumb, index, middle and half the ring finger.  This nerve also supplies power to the thumb muscles in the hand that moves the thumb into opposition (tip-to-tip pinch to the other fingers).
  • Common Symptoms
    • Pain in the wrist, thumb and hand. 
    • Pain may radiate to the elbow and even the shoulder.
    • Numbness and tingling, typically in the thumb, index and middle fingers and half of the ring finger with activity.
    • Nighttime numbness in the hand.
    • Feeling clumsy or frequently dropping objects.
    • In severe cases, the muscles at the base of the thumb may become soft or soggy and it becomes difficult to perform fine-motor activity such as picking up pills or coins or putting on earrings.

Common Treatments may include:
  • Use of a wrist brace, splint or orthotic at night to hold the wrist in a flat (neutral) position.  In this position, the canal has the largest volume.  More room in the tunnel means less pressure on the median nerve.
  • Implementing Ergonomic Improvements & Activity Modification
    • Perform activities with the wrist in as neutral a position as possible (wrist flat and not angled to one side or the other).
    • Avoid repetitive or sustained grasp of objects.
    • Avoid forceful grasping of objects, especially if the wrist is angled in an awkward position.
  • Use of Heat and cold 
    • Use cold packs for acute pain or swelling.
    • Use heat packs to control more chronic pain or to relax the muscles.
  • Wearing compression or Isotoner gloves at night may help control swelling and provide a comforting, neutral warmth.
  • Perform tendon and nerve gliding exercises.
  • Use of topical pain relieving creams if helpful and as needed.
  • Modalities such as ultrasound, electrical stimulation and iontophoresis may be helpful to reduce pain and inflammation.
  • Therapeutic taping may be helpful to reduce pain and tingling/numbness.
  • A short course of anti-inflammatory medications, such as NSAIDs, may be helpful as prescribed by an MD or over-the-counter (Advil, Aleve) if not contraindicated by other medical conditions.
  • A Cortisone injection into the carpal tunnel may reduce inflammation and symptoms.
  • If conservative treatment methods do not alleviate the symptoms, surgical options may be considered.

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