Carpal tunnel syndrome (CTS) is a condition brought on by increased pressure on the median nerve at the wrist. In effect, it is a pinched nerve (nerve compression) at the wrist. It is the most common pinched nerve condition in the upper extremity. Symptoms may include numbness, tingling, and pain in the arm, hand, and fingers. There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the nerve.
Usually the cause is unknown. Pressure on the nerve can happen in several ways: swelling of the lining of the flexor tendons, joint dislocations, fractures, and arthritis can narrow the tunnel; and keeping the wrist bent for long periods of time. Fluid retention during pregnancy can cause swelling in the tunnel and symptoms of carpal tunnel syndrome, which often go away after delivery. Thyroid conditions, rheumatoid arthritis, and diabetes also can be associated with carpal tunnel syndrome. There may be a combination of causes.
The diagnosis is made base on the patient’s presenting symptoms and physical examination. Dr. Goldberg may order nerve conduction and/or electromyogram (EMG) to confirm the diagnosis.
Treatment options vary from wrist splinting, steroid injection to the carpal tunnel, to surgical decompression of the carpal tunnel (carpal tunnel release). The treatment modalities depend on the severity of the compression of the median nerve. For mild to moderate carpal tunnel syndrome, Dr. Goldberg may try wrist splinting to keep the wrist in a straight position may help alleviate the pressure on the median nerve. With severe carpal tunnel syndrome, Dr. Goldberg will recommend surgical release of the carpal ligament that forms the roof of the carpal tunnel.