What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is a condition that affects the hand and wrist. It occurs when the median nerve, which runs from your forearm into the palm of your hand, becomes compressed or squeezed at the wrist.

The main symptoms of carpal tunnel syndrome include numbness or tingling, pain or discomfort, difficulty to grip, and weakness in the hand. These symptoms worsen during nighttime and when you wake up in the morning.

Risk factors for carpal tunnel syndrome include repetitive hand motions (such as typing or using tools), hand and wrist position (especially prolonged flexion or extension), underlying health conditions (like diabetes or arthritis), and pregnancy.

Treatment options for carpal tunnel syndrome range from conservative measures such as wrist splinting and modifications of activities, to more invasive options like corticosteroid injections or surgery in severe cases.

How is CTS diagnosed?

Diagnosing CTS generally involves thorough clinical evaluation and sometimes additional tests to confirm the diagnosis. Here are the common steps taken in diagnosing CTS:

●     Medical history and physical examination: Your doctor will begin by discussing your symptoms and medical history. They will inquire about your occupation, hobbies, and any activities that may contribute to repetitive hand or wrist movements. During the physical examination, they will assess your hand, wrist, and arm for signs of CTS, such as tenderness, swelling, or weakness.

●     Tinel's test: This is a simple physical exam maneuver where the doctor taps lightly over the median nerve in the wrist to elicit a tingling sensation or shock-like feeling in the fingers.

●     Phalen's test: In this test, you will be asked to flex your wrist gently and hold it in that position for a minute to see if it triggers symptoms like tingling or numbness in the fingers.

●     Electrodiagnostic tests: If the diagnosis is not clear from the history and physical exam, your doctor may recommend electrodiagnostic tests, such as:

○     Nerve conduction study (NCS): This test measures the speed and strength of electrical signals as they travel through the median nerve and can help determine if there is any nerve damage or compression.

○     Electromyography (EMG): This test measures the electrical activity of muscles. It is often done along with NCS to assess for any muscle damage related to nerve compression.

●     Imaging studies: X-rays or ultrasound may be used to rule out other conditions that can cause similar symptoms, such as arthritis or fractures.

●     Clinical judgment: Ultimately, the diagnosis of CTS relies on a combination of your symptoms, physical examination findings, and test results. Your doctor will consider all these factors to make an accurate diagnosis and recommend appropriate treatment options.

If you suspect you have CTS or are experiencing symptoms like numbness, tingling, or pain in your hand or wrist, it's essential to seek evaluation from a healthcare professional. Early diagnosis and treatment can help prevent worsening of symptoms and improve outcomes.

What are the symptoms of CTS?

CTS typically presents with a distinct set of symptoms that affect the hand and wrist. These symptoms can vary in severity and frequency including:

●     Numbness or tingling: The most common symptom of CTS is a sensation of numbness or tingling in the thumb, index finger, middle finger, and half of the ring finger. This sensation may occur intermittently or persistently and is often more noticeable at night.

●     Pain or discomfort: Individuals with CTS may experience pain or aching in the hand or wrist. The pain can sometimes radiate up the forearm or into the upper arm.

●     Weakness: As CTS progresses, weakness in the hand may develop. This can make it difficult to perform tasks that require fine motor skills or gripping objects firmly.

●     Burning or itching sensation: Some people with CTS report a sensation of burning or itching in the palm of the hand or fingers.

●     Difficulty with fine movements: Individuals may find it challenging to perform activities that require precise movements of the fingers or thumb, such as buttoning a shirt, typing, or writing.

●     Worsening symptoms at night: Many people with CTS experience worsening symptoms during the night or upon waking up in the morning. This is often due to sleeping with the wrist in a flexed position, which can further compress the median nerve.

●     Swelling in the fingers: In some cases, there may be swelling or puffiness in the fingers, without any apparent external cause.

Symptoms of CTS depend on the individual and may worsen if left untreated. If you suspect that you have CTS or any of its symptoms, it's advisable to consult with a healthcare professional for accurate diagnosis and appropriate management. Early intervention is important to help alleviate symptoms effectively.

What are the normal treatments for CTS?

The treatment for CTS depends on the severity of symptoms and can range from conservative measures to more invasive interventions. Here are the normal treatments for CTS:

●     Wrist splinting: Wearing a splint or brace on the wrist can help keep the wrist in a neutral position, relieving pressure on the median nerve. Splinting is often recommended, especially at night when symptoms may worsen due to sleeping positions.

●     Activity modification: Avoiding activities that aggravate symptoms or cause repetitive wrist movements can help reduce pressure on the median nerve. Ergonomic adjustments to your workspace or using ergonomic tools may also be beneficial.

●     Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help reduce pain and inflammation associated with CTS. Corticosteroid injections into the carpal tunnel may also be used to reduce swelling and alleviate symptoms.

●     Physical therapy: Specific exercises and stretching techniques can help improve strength and flexibility in the wrist and hand, reducing symptoms of CTS. Therapists may also use techniques such as ultrasound therapy to alleviate pain and inflammation.

●     Alternative therapies: Techniques such as acupuncture or yoga have been suggested to help alleviate symptoms in some individuals with CTS. These approaches may help by promoting relaxation, reducing muscle tension, and improving circulation.

●     Surgery: For severe or persistent cases of CTS that do not respond to conservative treatments, surgery may be recommended. Carpal tunnel release surgery involves cutting the ligament that forms the roof of the carpal tunnel to reduce pressure on the median nerve. This procedure can be performed using traditional open surgery or minimally invasive techniques.

●     Lifestyle changes: Making adjustments in daily activities to reduce repetitive wrist movements and taking breaks during tasks that strain the wrist can help prevent exacerbation of symptoms.

The choice of treatment depends on factors such as the severity of symptoms, the presence of underlying conditions, and individual preferences. A healthcare provider will typically tailor the treatment plan to address the specific needs of each person with CTS. Early intervention and appropriate management can help alleviate symptoms and improve hand function in individuals with carpal tunnel syndrome.

How does acupuncture help CTS patients?

Acupuncture can help relieve symptoms of carpal CTS through several potential mechanisms:

●     Pain relief: Acupuncture is known to stimulate the release of endorphins, which are natural pain-relieving chemicals in the body. By triggering these responses, acupuncture can help reduce the pain associated with CTS.

●     Anti-inflammatory effects: Acupuncture has been shown to have anti-inflammatory effects by reducing levels of pro-inflammatory markers in the body. Inflammation is a contributing factor to the compression of the median nerve in CTS, so reducing inflammation can help alleviate symptoms.

●     Improvement in nerve conduction: Some studies suggest that acupuncture may help improve nerve conduction, including the function of the median nerve in CTS. This improvement can lead to reduced numbness, tingling, and other sensory disturbances.

●     Muscle relaxation: Acupuncture can help relax muscles and reduce muscle tension in the forearm and hand, which may contribute to symptoms of CTS.

●     Promotion of blood circulation: By stimulating acupuncture points, blood circulation to the affected area can be improved. Enhanced circulation helps deliver nutrients and oxygen to tissues, promoting healing and reducing pain.