Overview
Carpal Tunnel Syndrome is a condition where the median nerve gets compressed at the wrist, leading to numbness, tingling, burning sensation and/or pain in the hand.
The carpal tunnel is a narrow passageway on the underside of the wrist, formed by bones and a firm band of tissue (the transverse carpal ligament). The median nerve, along with nine tendons, passes through this tunnel to supply sensation and movement to the thumb, index, middle, and part of the ring finger. When the tunnel becomes narrowed or its contents swell, the median nerve gets squeezed, causing the characteristic symptoms of Carpal Tunnel Syndrome.
Why does Carpal Tunnel Syndrome happen?
Anything that reduces the space inside the carpal tunnel or increases the volume of its contents can compress the median nerve. This includes swelling of the tendons that run through the tunnel, fluid retention, or bony changes around the wrist. Over time, repeated pressure on the nerve can damage its ability to transmit signals normally, resulting in pain, weakness, and altered sensation in the hand.
Who gets Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is more common in diabetics, patients with hypothyroidism, and those with rheumatoid arthritis. People who perform repetitive hand and wrist activities — such as keyboard users, musicians, and assembly line workers — are at higher risk. Pregnant women during pregnancy or post-delivery are also likely to develop Carpal Tunnel Syndrome due to fluid retention and hormonal changes.
Common symptoms include:
- Numbness or tingling in the thumb, index, middle, and ring fingers
- Burning sensation in the hand, especially at night
- Pain radiating from the wrist up the arm or into the fingers
- Weakness in grip and difficulty holding objects
- Tendency to drop things due to reduced sensation or strength
Natural History (Progression of disease in the absence of treatment)
Carpal Tunnel Syndrome is a progressive condition if left untreated. Symptoms typically begin as intermittent tingling or numbness, often waking the patient from sleep. Over time, the numbness can become constant and grip strength may weaken significantly. In advanced cases, the muscles at the base of the thumb (thenar muscles) can waste away, causing permanent loss of dexterity. Early intervention significantly improves outcomes and avoids irreversible nerve damage.
When to seek medical help?
Clinical assessment is sufficient to diagnose Carpal Tunnel Syndrome in most cases. Simple bedside tests such as Phalen's test and Tinel's sign can confirm the diagnosis. X-rays are generally unnecessary. If the diagnosis is in doubt, or if the condition has been present for a long time, a nerve conduction study (NCS) may be recommended to assess the extent of nerve compression.
What happens when I visit the Consultant?
You will be asked about the nature and duration of your symptoms, which fingers are affected, and whether the symptoms are worse at night or with specific activities. The consultant will examine your hand, wrist, and neck to rule out other causes. In most cases, an MRI scan is not required during the initial assessment. Blood tests to check for blood sugar levels and thyroid hormone levels may be requested, as these conditions commonly contribute to Carpal Tunnel Syndrome.
What are the Treatment Options?
Carpal Tunnel Syndrome treatment options range from wrist splinting and activity modification to a steroid injection into the carpal tunnel, or carpal tunnel release surgery, depending on the severity and duration of symptoms.