Carpal Tunnel Syndrome (CTS) What is carpal tunnel syndrome (CTS)? The carpal tunnel is a tunnel in your wrist through which nine tendons (these control the movement of your fingers and thumb) and a large nerve (median nerve) pass. Over the front of the wrist there is a ligament and this forms the roof of the tunnel. The floor of tunnel is formed by the carpal bones. When the median nerve becomes irritated or squashed within this tunnel this is called Carpal Tunnel Syndrome (CTS). CTS is a common hand condition and is referred to as a “compressive neuropathy”. Diagram 1: Picture of the Site of Compression for Carpal Tunnel 1 What are the symptoms of CTS? The main symptom of CTS is altered feeling in the hand, often felt or described as pins and needles and/or numbness. Pain can also be felt but this is usually less common. The median nerve gives feeling to the thumb, index, middle and the thumb side of the ring finger. This is why people who have CTS normally feel their symptoms more so in these digits. Diagram 2: Picture of Where Altered Sensation for Carpal Tunnel Occurs The symptoms experienced with CTS can often be felt more so; At night (sleep can be disturbed) First thing in the morning Carrying out activities which involve gripping (for example, holding the phone, driving and reading). In more severe cases the altered feeling may become more continuous. There may also be weakness and wasting (loss of muscle bulk) at the base of the thumb. In advanced or severe cases, some patients with CTS may describe a feeling of clumsiness and/or find they are dropping objects easily. The majority of people with CTS have much milder symptoms that come and go but these rarely affect the ability to carry out activities involved with daily living. 2 How common is Carpal Tunnel Syndrome? Carpal Tunnel Syndrome (CTS) is a common condition of the upper limb. About 7%-11% of the population will experience CTS symptoms at some point in their lifetime. CTS is three times more common in women than men. CTS can occur at any age and occurs in both men and women but most commonly affect women in middle age. What causes it? In most people, the cause of Carpal Tunnel Syndrome is not known. Anything that reduces the space within, or increases the pressure within the Carpal Tunnel, can potentially lead to symptoms of Carpal Tunnel Syndrome. Factors that have strong evidence supporting an increased risk of Carpal Tunnel Syndrome include, obesity or being significantly overweight. Other factors that have been associated with an increased risk of Carpal Tunnel Syndrome include: o Overuse of the hand and wrist such as in gardening or renovating a house, activities requiring forceful grip/exertion (evidence on an association between computer work and Carpal Tunnel Syndrome is variable) o Osteoarthritis and rheumatoid arthritis o Wear and tear in your tendons or inflammation of your tendons o Hypothyroidism o Diabetes o Wrist trauma o Pregnancy Tests for Carpal Tunnel Syndrome Usually the diagnosis of CTS is made of the basis of your story about your symptoms. Symptoms of CTS tend to follow certain patterns and most patients report similar things. Examining the hand is helpful too. Most patients with CTS will find the splint and exercises in the following section helpful. This information can help to confirm, or exclude, the diagnosis and explains why patients are often encouraged to try this first. 3 Some patients require electrical tests called nerve conduction studies. This is often because the diagnosis is in doubt or because you have diabetes. These tests can provide some evidence to confirm the CTS diagnosis and the level of severity. Blood tests Some conditions can cause symptoms similar to CTS, or make the symptoms of CTS worse. This is known as peripheral neuropathy. Therefore, your health care professional may request that you have simple blood testing to check for diabetes and to check that your thyroid, folate and Vitamin B12 levels are within are normal limits. Carpal Tunnel Syndrome Myths vs Facts Myth Everyone with Carpal Tunnel Syndrome needs an operation Fact The symptoms of Carpal Tunnel Syndrome can settle on their own. Many cases settle with simple treatment or advice. If your symptoms do not settle with simple treatment or advice other treatments are available but not everyone will require these treatments. 4 .