Common Questions About Carpal Tunnel Syndrome

What is it?

Carpal tunnel syndrome (CTS) is a condition where the median nerve is compressed under the transverse carpal ligament, located over the base of the palm (Figure 1). The symptoms are: pins-and-needles, numbness and even pain over the tips of the thumb, index, middle and radial half of the ring fingers. In its severe condition, CTS may cause sleeplessness due to pain and the feeling of the affected hand being swollen and “tight” that awakens the afflicted in the middle of the night. Massaging the hand and shaking it usually alleviates these symptoms temporarily, only for them to recur and attack repetitively. Left unchecked, in end-stage CTS, the thenar muscles controlling movements of the thumb become weakened and wasted (Figure 2). This results in irreversible functional disability of the hand. Simple tasks such as buttoning one’s shirt or blouse, using a pair of chopsticks and picking up small objects, for instance, become a great challenge once thenar muscle atrophy ensues. Therefore, it is imperative that CTS is diagnosed and treated early to prevent the onset of irreversible muscle wasting and dysfunction of the hand.

Figure 1. The median nerve compressed
under a tight and thickened
transverse carpal ligament.

Figure 2. Thenar muscle wasting
in end-stage CTS.

Who gets this and why?

CTS is commonly associated with age, the female gender, existing medical conditions such as diabetes mellitus, hypothyroidism, rheumatoid arthritis and gout. However, most cases of CTS are of idiopathic cause.

How do I know if I have CTS?

If the symptoms match the above description, a consult with a qualified Hand Surgeon will enable one to obtain a definitive diagnosis. This is done through a thorough and detailed medical history, followed by clinical examination of the hands. A nerve conduction study can be arranged to evaluate the function of the median nerve and to ascertain the location and severity of the compression of this nerve.

I have been diagnosed with CTS. What are the treatment options?

Mild symptoms of CTS can be treated with modest lifestyle changes and activity modification, accompanied by oral medication and the application of a wrist splint. If symptoms persist, one may need surgery.

A Hand Surgeon will advise if the condition requires surgical intervention. Factors to consider:

• Age over 55 years
• Duration over 10 months
• Constant paraesthesia
• Stenosing flexor tenosynovitis
• Phalen’s test positive < 30 seconds

Source: Kaplan, Glickel, Eaton (J Hand Surg 1990)

Why see a Hand Surgeon for CTS?

Hand Surgeons have vast experience in managing conditions of the hands and wrist exclusively. They are also well-equipped with skills and knowledge to handle neglected cases of CTS as well as recalcitrant cases with previous surgery done. For instance, in recalcitrant CTS requiring surgery, Hand Surgeons perform microsurgical neurolysis to release tight scar tissue around the median nerve. If necessary, soft tissue is transferred onto the bare median nerve after this is done to protect it from recurrent scarring and return of symptoms. A hypothenar fat pad flap transfer is one example of a soft tissue coverage procedure that is done in this situation (Figure 3).

Figure 3. A pedicled hypothenar fat pad flap
used to cover the median nerve in revision surgery.