What is Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The carpal tunnel—a narrow, rigid passageway of ligament and bones at the base of the hand—houses the median nerve and the tendons that bend the fingers.

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Quiz: Do You Understand Carpal Tunnel Syndrome?

Test your knowledge by answering the following questions:

Questions
True
False
1

Most patients experience numbness in the middle of the day rather than at night or in the morning.

Explanation:
Most patients experience numbness at nighttime or in the morning, as the tendons swell overnight. After they wake up and move their fingers, the fluid moves out of the tendons and the numbness usually goes away.
2

In more severe cases, pain can radiate up to the shoulder.

Explanation:
As carpal tunnel syndrome symptoms worsen, patients experience numbness and pain in the daytime whenever the wrist is bent or extended. Pain is felt in the palm of the hand and the forearm, with occasional radiation up to the shoulder.
3

Hyperthyroidism is a risk factor for carpal tunnel syndrome.

Explanation:
People whose jobs involve heavy gripping or vibrating tools often develop carpal tunnel syndrome. Other risk factors include hypothyroidism and inflammation of the tendons from rheumatoid arthritis. Many pregnant women develop carpal tunnel syndrome as a consequence of the swelling that they have through pregnancy.
4

The typical treatment for carpal tunnel syndrome includes splinting during the night.

Explanation:
The typical treatment for carpal tunnel syndrome includes splinting during the night. These are hard splints that help to immobilize the wrist and decrease the pressure that is being applied to the wrist.
5

If the condition progresses and becomes more severe, you may need surgery.

Explanation:
Other carpal tunnel syndrome treatment methods include anti-inflammatories, cortisone injections into your carpal canal and physiotherapy. If the condition progresses and becomes more severe, you may need surgery.
(Answer all questions to activate)

Gordon Bohlmann, BSc.PT, IMS, Physiotherapist, discusses what is a triangular fibrocartilage complex injury of the wrist (TFCC)

Dr. Herb VonSchroeder, MD, FRCSC, Orthopaedic Surgeon, talks about carpal tunnel syndrome and the various treatment options available to patients

Dr. Bert Perey, MD, FRCPC, Orthopedic Surgeon, discusses carpal tunnel syndrome symptoms and treatment including physiotherapy, bracing and surgical options.

What is Carpal Tunnel Syndrome and How is it Treated? - Marpole Physiotherapy

Carpal tunnel syndrome really is a condition of a nerve. It’s a neuropathy, which means that the nerve is not functioning as well as it should. It pertains to the median nerve, which is one of the nerves that run down the arm from the neck to the hand.

So the carpal tunnel is located in the wrist right about this region between the thumb side and the small finger side of the hand and it’s made up of the carpal bones in the wrist – there’s seven of them – and a tunnel is created by some soft tissue, which runs across the top through the tunnel.

We have some of the flexor tendons of the forearm that will move the fingers and the median nerve. And when that median nerve gets pushed on we get the signs and the symptoms of carpal tunnel syndrome.

Typically, if you have carpal tunnel syndrome you’d be feeling the pain on the thumb side of the hand and the first three-and-a-half fingers, and this is also where you would get the tingling and the numbness and the thumb muscles are where they would get really weak and eventually you would get wasting of the thumb muscles where they got smaller and atrophied.

So if you think that you have symptoms of carpal tunnel syndrome it’s important for you to be assessed right away by your doctor or your physiotherapist. Your physiotherapist will do some special tests such as a balance test or the tunnel tap sign to determine whether or not you have Carpal Tunnel Syndrome.

Once that’s been determined the physiotherapist will address the treatment specifically at the nerve to find ways of decompressing the nerve, and we have various ways of doing that.

They’re all conservative and non-surgical. And they’ll be various different plans based on the various patient types that we see. We may address your neck and shoulder as well, but the important thing is to be assessed.

And so if you think you have any of these signs and symptoms or you’re worried or you have questions about it see your local physiotherapist today.

Presenter: Gordon Bohlmann, Physiotherapist, Vancouver, BC

Local Practitioners: Physiotherapist

Dr. Bert Perey, MD, FRCPC, Orthopedic Surgeon, discusses carpal tunnel syndrome symptoms and treatment including physiotherapy, bracing and surgical option

When you start developing symptoms of carpal tunnel syndrome, and your diagnosis has been confirmed by your family physician, sometimes an added diagnosis is getting something called a nerve conduction study, where you’re sent to a neurologist to test the level of slowing of that nerve.

That test will often come back positive, and it will give you some idea of the degree of compression; not that that’s related, necessarily, to your symptoms, but it does help confirm the diagnosis.

Not all doctors will need a positive nerve test to make the diagnosis if you have classic symptoms of carpal tunnel syndrome. Early in the disease, in the entity, when you start having numbness in your hands, most physicians will recommend bracing at nighttime. It will keep your wrist in a straighter position.

They may ask you to avoid positions of extreme extension or flexion of your wrist joint during the daytime at work, or at hobbies or sports that you do.

And most commonly this is done with a brace, they can ask you to maybe avoid certain activities that may involve a lot of prolonged gripping. It’s a springtime, you’re involved in house care, gardening, you’re doing a lot of that, your symptoms are getting worse, they may advise you “It’s okay; just hold off on that a bit, it may settle down.”

They may put you on some anti-inflamatories to settle some of your symptoms, and some doctors will actually inject cortisone into your carpal canal that may help you temporarily.

The problem is, by and large, this is a progressive problem. So you may have mild symptoms for one day, and worse another, and month-to-month it may change. But the natural course of this is over years it will usually get worse.

That doesn’t mean you need an operation for this, or you need to run to your doctor, but just understand the natural course is for it to get worse.

Most of our allied health people will help you manage the symptoms, and perhaps delay the need for surgery. But ultimately you end up having symptoms on a daily basis, you probably want to see your doctor, to seek attention from a surgeon who deals with carpal tunnel syndrome.

The principles of surgery are simply to release this ligament that we talked about earlier on. It literally is about two centimeters in length, and it involves an incision to cut it. I make the analogy that if your waist is 40 inches in diameter and you have a 28 inch belt, what you need to do is cut the belt. It makes you feel better.

So this is a tight belt around your wrist. Just cutting the belt in itself will often relieve all of the symptoms of numbness, pain and issues that you’re having related to the carpal canal.

Now, there are basically two ways of cutting this tunnel. You can go right over the top with a small blade; a small incision is made where the ligament is cut. Or there’s another technique where people can go in through a camera from the inside of the tunnel and cut it from inside-out.

This is called endoscopic surgery. The results of both of these techniques are essentially the same, and the outcomes are exactly the same.

If you think you have carpal tunnel syndrome, you should seek attention from your family doctor to confirm the diagnosis and seek treatment.

Presenter: Dr. Bertrand Perey, Orthopaedic Surgeon, New Westminster, BC

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