Carpal tunnel syndrome is a clinical condition which results from compression of the median nerve at the wrist joint, when it pass under the transverse carpal ligament. it’s a common condition that causes pain, numbness, and tingling in the hand and arm.
The symptoms of this condition include hand pain, numbness and tingling sensation , which sometimes extend to the forearm and even to the arm. however symptoms are mainly localised to the lateral border of the hand, thumb, index and middle fingers. In severe cases, weakness and clumsiness in the hand with hand grip weakness associated with wasting of the small muscles of the hand, best manifested at the base of the thumb muscles (thinner eminence). In chronic severe condition, it may lead to hand deformity. Night-time symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken the patient from sleep. During the day time, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book. Many patients find that moving or shaking their hands helps relieve their symptoms. Diagnosis of the disease is usually clinical, confirmed by Neurophysiological studies and imaging in form of U/S and MRI scan.
CTS is a progressive disease, with an insidious deterioration. sometimes, the symptoms gets worse suddenly after unusual physical activities that may strain the wrist joint which cause trauma and swelling of the median nerve, in a very restricted carpal tunnel space. This would lead to significant worsening of the symptoms. The keystone in the management of CTS is early diagnosis and treatment. Mild and moderate CTS sometimes respond to a simple measures like wearing a wrist splint or avoiding certain activities. Sometimes carpal tunnel injection may give symptomatic relive to patients with mild to moderate compression.
In severe cases, reflected by significant and severe changes in the neurophysiological studies,continuous pressure on the median nerve may lead to nerve damage and worsening symptoms. in these cases, surgical option is recommended to prevent further neurological deterioration and irreversible nerve damage. The procedure to take the pressure from the median nerve at the wrist joint is called Carpal Tunnel Decompression.