Definition & Overview
Carpal tunnel syndrome (CTS) is a disorder of the median nerve located within the carpal tunnel. The condition results in a variety of symptoms, such as pain, weakness of the hand muscles, numbness of the fingers, and skin dryness. The condition may disappear on its own without medical intervention, but most of the time, the symptoms need to be treated by injecting an anaesthetic or corticosteroid into the area.
The carpal tunnel is the inner portion of the wrist. It is surrounded by eight carpal bones on one side and a ligament called the retinaculum on the other. Located inside the carpal tunnel are various tendons and the median nerve, one of the pathways used by the brain to send signals to different parts of the body. It is thought that the primary cause of CTS is the compression of the median nerve. When the nerve is compressed, the signals to and from the hands and the brain are disrupted. This is why people with CTS often feel a tingling sensation in their fingers and other symptoms.
However, the exact causes why the median nerve becomes compressed remain unclear. Some factors may contribute to this condition, such as wrist injuries, obesity, diabetes, arthritis, pregnancy, and even a family history of CTS. Repetitive motion, such as work-related activities that involve hand and wrist movement, may also be a contributing factor.
In some cases, doctors may recommend a wait-and-see approach instead of providing medical treatment right away, especially if the symptoms have been present for less than a month. If the symptoms continue, non-surgical treatment will be recommended. If non-surgical methods fail, the only option would be to attempt to release pressure on the median nerve using surgery.
One of the first non-surgical methods that will likely be recommended by a doctor is the injection of corticosteroid into the area. This method may at times coincide with another method called wrist splinting, which is basically attaching a splint to the wrist to limit its movement.
Who Should Undergo & Expected Results
Carpal tunnel syndrome is a common condition. It is important to understand that although there are risk factors, the exact cause of the condition may never be identified. As such, avoiding the risk factors will not guarantee relief from CTS.
Patients who are experiencing the symptoms of CTS for over a month need to consult their doctor. The symptoms may appear mild at first, but there is a possibility that they will increase in severity without medical treatment.
However, some studies show that the symptoms simply disappear within a year. Some women who experience the symptoms of CTS during pregnancy have also reported relief from such symptoms after giving birth.
Therefore, it can also be possible for a doctor to recommend monitoring the condition, especially if the symptoms are mild.
If the patient requires medical treatment, a doctor would recommend the injection of corticosteroid in most cases. Some doctors may also include an anaesthetic, but studies have not confirmed any added benefits.
Patients usually respond well to a single injection of corticosteroid. However, if the procedure does not provide significant symptoms relief, it may need to be repeated.
It is important to understand that corticosteroid is a type of steroid. It may be taken in tablet form, but it is usually injected directly into the wrist of a person with CTS. If taken regularly or abused, there will likely be serious repercussions.
If symptoms persist, the doctor may recommend surgery instead of regularly injecting corticosteroids into the target area.
How is the Procedure Performed?
Patients who complain of CTS symptoms usually don’t need to undergo complex diagnostic procedures. A simple description of the symptoms and a physical examination of the hand and wrist should be enough for a doctor to provide a diagnosis of CTS.
In some cases, the doctor may request for an ultrasound of the wrist. Ultrasound can identify any swelling in the area or swelling of nearby tendons that may be applying undue pressure to the nerve.
Since there are quite a number of risk factors, the doctor may need to request for the patient’s medical history. Doctors may also need to know if the patient has current medical conditions or if the patient is taking any medications.
Even though treatment of medical conditions that may contribute to CTS cannot guarantee relief of the symptoms, the doctor may still recommend that the patient be seen by other specialists as well.
As mentioned earlier, doctors will usually inject corticosteroid for a limited number of times if symptoms persist. They will inject the medication directly into the wrist to maximise its effects.
Possible Risks and Complications
The use of steroids over an extended period without medical supervision can be dangerous. Patients are often informed that although corticosteroids may provide significant symptoms relief, the symptoms may return over time.
It is also possible for the symptoms to temporarily increase in severity within three days after the injection. This is a normal response to the corticosteroid and should not be a cause for concern.
However, if the symptoms do not subside after three days, the patient will need to seek further medical attention.
Iain Duncan MD, Wes Cormick MD; “Carpal Tunnel Ultrasound and Injection”; http://www.insideradiology.com.au/pages/view.php?T_id=121#.V-JRiVt97ow
Alfred F. Tallia MD MPH, Dennis A Cordone DO; “Diagnostic and Therapeutic Injection of the Wrist and Hand Region”; http://www.aafp.org/afp/2003/0215/p745.html