Carpal Tunnel Syndrome

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We diagnose and treat many patients who present with this but, what is Carpal Tunnel Syndrome (CTS)?

It is a constellation of symptoms that usually starts with numbness and tingling of one hand or both, involving the thumb, pointer and long fingers along the palm-side of the hand. We typically hear that it is worse with computer use, driving and all types of repetitive hand motions. CTS can often wake one up in the night with patients reporting the classic “flicking” of the hands to try to “wake them up”. The underlying problem is irritation of the Median nerve as it runs through the carpal tunnel at the wrists.

The Median nerve is usually irritated by the thickening of the transverse carpal ligament. CTS can be diagnosed by history and physical examination, ultrasound (US) measurements as well as by EMG and nerve conduction study (NCS) testing.

In EMG/NCS, the physician is looking for slowing and/or loss of electrical test signals sent along the course of the nerve and in more severe cases, electrical changes in the muscle(s) supplied by the nerve.

 

US can be used for visualizing the compressed nerve as well as for needle guidance for therapeutic injection(s) in the carpal tunnel area.

One can actually have CTS and not have EMG/NCS abnormalities, as the nerve may only be irritated enough to cause symptoms intermittently but not compressed significantly enough to cause nerve signal abnormalities.  In these cases, it can be treated conservatively with night splinting, Class IV laser treatment and physical or occupational therapy. More aggressive cases with NCS slowing can be treated with conventional steroid injections or may respond longer term with a regenerative medicine technique called platelet lysate. More severe cases showing ongoing nerve damage usually can be successfully treated with carpal tunnel release surgery.

If you believe you have CTS, come see us for an evaluation.

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