Brief Overview: According to UpToDate, “Carpal tunnel syndrome (CTS) refers to the complex of symptoms and signs brought on by compression of the median nerve as it travels through the carpal tunnel in the wrist. Patients commonly experience pain, paresthesia, and, less commonly, weakness in the median nerve distribution. CTS is the most common compressive focal mononeuropathy seen in clinical practice.”
Prevalence: According to UpToDate, “the estimated prevalence of CTS in the general population is between 1 and 5 percent.”
Etiology: According to the National Institute of Arthritis and Musculoskeletal and Skin Disease, “Researchers do not know the causes of carpal tunnel syndrome. The condition CTS may result from a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Sometimes, irritated tendons can thicken or swell, which can narrow the tunnel and compress the median nerve. In many cases, no single cause can be identified.”
Risk Factors:
- Age
- Female
- Genetics
- Diabetes
- Arthritis
- Obesity
- Thyroid disease
- Pregnancy
- Trauma
- Amyloidosis
- Repetitive hand/wrist use
Commonly Associated Conditions:
- Hypothyroidism
- Osteoarthritis
- Rheumatoid arthritis
- Diabetes
- Obesity
Common Medications:
- Glucocorticoid injection
- Oral glucocorticoids
Common Labs, Imaging, and Tests:
- Sensation testing in the upper extremities
- Strength testing in the hands
- Phalen, Tinel, manual carpal compression, hand elevation tests
- Electrodiagnostic testing (nerve conduction study, needle electromyography (EMG))
- Ultrasound, MRI
Common Symptoms:
- Pain, discomfort in the hand, wrist, forearm, upper arm
- Numbness, tingling in the hand
- Weakness or clumsiness when using the hands
Common Treatments:
- Nocturnal wrist splinting in the neutral position
- Yoga
- Physical, occupational therapy
- Ultrasound therapy
- Surgery may be indicated for severe or persistent symptoms
Physical Findings:
- Positive Phalen’s test (wrist flexion reproduces symptoms)
- Positive Tinel’s sign (tapping median nerve causes tingling)
- Decreased sensation in median nerve distribution
- Thenar muscle weakness or atrophy in advanced cases
- Reduced grip strength
Potential Complications and Contraindications:
- Complications of untreated CTS: permanent nerve damage, thenar muscle atrophy, chronic pain, loss of hand function.
- Contraindications:
- NSAIDs not recommended
- Electrical, magnetic, and laser therapies are not recommended
- Long-term opioids for CTS (not recommended)
- Repeated corticosteroid injections (risk tendon/nerve damage)
- Surgery contraindicated in patients who cannot tolerate anesthesia or with poor wound healing (severe uncontrolled diabetes, vascular disease).
General Health and Lifestyle Guidance:
- Ergonomic modifications (neutral wrist position, frequent breaks) can be helpful
- Wrist splints during sleep and aggravating activities can help relieve symptoms
- Work with your healthcare provider on weight management and to optimize diabetes/thyroid control if applicable
- Avoid repetitive forceful gripping/vibrating tools as much as possible
- Stretching and strengthening exercises for hand/wrist can be helpful
Suggested Questions to Ask Patients:
- When did symptoms start, and are they worse at night?
- Which fingers are affected?
- Do you drop objects or feel weaker when gripping?
- What activities worsen or relieve symptoms?
- Do you have diabetes, thyroid disease, or arthritis?
- Have you tried splinting, medications, or injections before?
- Are symptoms affecting work, hobbies, or daily living?
Suggested Talking Points:
- CTS is common and often treatable without surgery.
- Splinting at night and activity modification can help relieve symptoms.
- Injections may provide temporary relief; surgery is very effective if needed.
Sources:
- https://www.uptodate.com/contents/carpal-tunnel-syndrome-clinical-manifestations-and-diagnosis?search=carpal%20tunnel%20syndrome&source=search_result&selectedTitle=2~143&usage_type=default&display_rank=2
- https://www.uptodate.com/contents/carpal-tunnel-syndrome-treatment-and-prognosis?search=carpal%20tunnel%20syndrome&topicRef=5258&source=see_link
- https://www.uptodate.com/contents/carpal-tunnel-syndrome-pathophysiology-and-risk-factors?sectionName=ANATOMY&search=carpal%20tunnel%20syndrome&topicRef=5288&anchor=H2&source=see_link#H2
- https://www.niams.nih.gov/health-topics/carpal-tunnel-syndrome
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.