Knowledge Café: Understanding and Managing Carpal Tunnel Syndrome at RWJUH Hamilton

Carpal tunnel syndrome (CTS) is a prevalent condition that affects many individuals, causing discomfort and impairing daily activities. At RWJUH Hamilton, experts offer insights into understanding, diagnosing, and managing this condition for improved patient outcomes.

Recognizing Symptoms

Carpal tunnel syndrome typically presents with pain, tingling, and numbness in the hand and wrist. These symptoms primarily impact the palmar side of the thumb, index, and middle fingers, and can extend to the radial half of the ring finger. Recognizing these early signs is crucial for effective management.

Diagnosis Techniques

Diagnosing carpal tunnel syndrome usually begins with assessing symptoms and conducting physical examinations. Key tests include:

• Tinel Sign: Tapping the volar surface of the wrist to check for tingling sensations.
• Phalen Maneuver: Flexing the wrist to elicit numbness or tingling.
• Median Nerve Compression Test: Applying direct pressure over the transverse carpal ligament.

For confirmation, electrodiagnostic studies such as nerve conduction studies and electromyography are utilized. These tests help determine the severity and rule out conditions like polyneuropathy or radiculopathy. Ultrasonography also aids diagnosis by measuring the cross-sectional area of the median nerve.

Physical Examination

During a physical exam, practitioners look for signs such as thenar atrophy and weakness in thumb opposition and abduction. These findings help gauge the extent of nerve involvement and guide treatment plans.

Treatment Options

Conservative Treatments

Initial management strategies focus on conservative measures, which include:

• Ergonomic improvements in the workplace.
• Wrist splinting, especially at night.
• Pain relief through analgesia and local corticosteroid injections.
• Physical therapy modalities such as therapeutic ultrasound and nerve glide exercises.
• Alternative approaches like yoga and carpal bone mobilization.

Surgical Treatment

When conservative treatments do not provide relief or if symptoms are severe, surgical intervention may be necessary. Surgical decompression involves severing the transverse carpal ligament to alleviate pressure on the median nerve. Surgical options include open or endoscopic techniques, both offering similar efficacy with endoscopic surgery potentially facilitating a quicker return to normal activities.

Management and Prevention Strategies

Addressing underlying health conditions such as diabetes, rheumatoid arthritis, or hypothyroidism is important in managing symptoms. Modifying daily activities to minimize repetitive wrist motions and increasing wrist protection can also prevent further irritation and manage existing symptoms.

Recovery Timeline

Recovery from non-surgical treatments varies, typically taking several weeks to months, whereas surgical recovery may extend up to a few months. Following medical advice and adhering to rehabilitation protocols are essential for optimal recovery.

Conclusion

By understanding the intricacies of carpal tunnel syndrome and exploring available diagnostic and treatment options, individuals can better cope with this condition. RWJUH Hamilton continues to provide valuable resources and expert care for individuals experiencing carpal tunnel syndrome, ensuring informed and effective management strategies.