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Carpal Tunnel Syndrome

When any of the nine long flexor tendons passing through the carpal tunnel swell or degenerate, the narrowing of the canal often results in the median nerve becoming entrapped or compressed.

PubMed Health Glossary
(Source: Wikipedia)

About 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. The median nerve provides feeling to the palm side of the thumb and to the index, middle, and part of the ring fingers (although not the little finger). It also controls some small muscles at the base of the thumb.

Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be numbness, weakness, or sometimes pain in the hand and wrist, or occasionally in the forearm and arm. CTS is the most common and widely known of the entrapment neuropathies, in which one of the body's peripheral nerves is pressed upon....Read more about Carpal Tunnel Syndrome NIH - National Institute of Neurological Disorders and Stroke

What works? Research summarized

Evidence reviews

Surgical versus non‐surgical treatment for carpal tunnel syndrome

Carpal tunnel syndrome is caused by compression of the median nerve which goes through the carpal tunnel in the wrist. It causes tingling, numbness and pain, mostly in the hand. Treatment is controversial. This review aimed to compare surgical decompression with non‐surgical treatments such as splinting or corticosteroid injections. Four trials were found and included, while three are awaiting assessment. The results suggest that surgical treatment is probably better than splinting but it is unclear whether it is better than steroid injection. Further research is needed for those with mild symptoms.

Surgical treatment options for carpal tunnel syndrome

There is no strong evidence for the replacement of standard open carpal tunnel release (OCTR) by alternative surgical procedures for the treatment of carpal tunnel syndrome. The decision to apply special, minimally invasive operations instead of standard OCTR seems to be guided by the surgeon's and patient's preferences.

Local corticosteroid injection is effective in the short‐term for the treatment of carpal tunnel syndrome

Local corticosteroid injection is a common non‐surgical treatment for carpal tunnel syndrome. Other non‐surgical treatments include the use of wrist splints, ultrasound and oral anti‐inflammatory agents. Surgical intervention is also known to be effective. This systematic review confirmed the effectiveness of local corticosteroid injection for relief of symptoms for severe carpal tunnel syndrome up to one month after injection. Local corticosteroid injection provides significantly greater clinical improvement compared to oral corticosteroid up to three months after treatment. Two injections of local corticosteroid do not provide significant further clinical improvement of symptoms. Further research is required to determine length of benefit of local corticosteroid injection and benefit for mild and moderate carpal tunnel syndrome.

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Summaries for consumers

Carpal tunnel syndrome: Wrist splints and hand exercises

Many people who have carpal tunnel syndrome have mild or moderate symptoms that come and go. In those cases, wearing a splint and avoiding too much stress on the joint may be enough to provide relief. The main symptoms of carpal tunnel syndrome are tingling, numbness or pain in parts of the hand. Sometimes it's difficult to move your thumb or first two fingers properly too. This is caused by too much pressure on the median nerve, which runs through the carpal tunnel in the wrist. Sometimes these symptoms disappear again without treatment. A wrist splint can be worn for support. Splints don't always offer enough relief from symptoms, but have hardly any side effects compared with other treatment options, like corticosteroid therapy or surgery.

Carpal tunnel syndrome: How effective are corticosteroid treatments?

Treating carpal tunnel syndrome symptoms with corticosteroids can provide temporary relief. Corticosteroid injections into the carpal tunnel are more effective than corticosteroids taken as tablets. Pain, tingling or numbness in your hand may possibly be caused by carpal tunnel syndrome. In carpal tunnel syndrome, the median nerve that runs through the carpal tunnel in your wrist is squashed. This nerve leads to the ball of the thumb and other parts of the hand. Injecting corticosteroids (steroids) is one of the most effective treatments available. Natural steroids are made in the adrenal glands. They have various effects, such as reducing inflammation and swelling. The steroids used in medications are made artificially. In the treatment of carpal tunnel syndrome, corticosteroids are typically considered if wearing a splint hasn't made any difference. The corticosteroid can either be injected into the tissue as a solution or taken as a tablet. The injections are more common and more effective than the tablets.

Surgical versus non‐surgical treatment for carpal tunnel syndrome

Carpal tunnel syndrome is caused by compression of the median nerve which goes through the carpal tunnel in the wrist. It causes tingling, numbness and pain, mostly in the hand. Treatment is controversial. This review aimed to compare surgical decompression with non‐surgical treatments such as splinting or corticosteroid injections. Four trials were found and included, while three are awaiting assessment. The results suggest that surgical treatment is probably better than splinting but it is unclear whether it is better than steroid injection. Further research is needed for those with mild symptoms.

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Terms to know

Flexor
A muscle whose contraction acts to bend a joint or limb.
Neuropathy
A nerve problem that causes pain, numbness, tingling, swelling, or muscle weakness in different parts of the body. It usually begins in the hands or feet and gets worse over time. Neuropathy may be caused by physical injury, infection, toxic substances, disease (such as cancer, diabetes, kidney failure, or malnutrition), or drugs, including anticancer drugs.
Rheumatologist
Doctors who diagnose and treat diseases of the bones, joints, muscles, and tendons, including arthritis and collagen diseases.
Tendons
Tough, fibrous, cord-like tissue that connects muscle to bone or another structure, such as an eyeball. Tendons help the bone or structure to move.

More about Carpal Tunnel Syndrome

Photo of an adult woman

Also called: Median nerve entrapment, Median nerve compression, CTS

Other terms to know: See all 4
Flexor, Neuropathy, Rheumatologist

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