CTS stands for carpal tunnel syndrome. Carpal tunnel syndrome is pressure damage to nerves in the wrist caused by a cavity in the carpal canal. The disease must be treated, otherwise it will lead to consequential damage that can significantly limit the function of the affected hand.
What is carpal tunnel syndrome?
Graphic representation of the anatomy of the hand, carpal tunnel, median nerve and carpal ligament. See AbbreviationFinder for abbreviations related to CTS.
Carpal Tunnel Syndrome (KTS or CTS) is a wrist condition where pressure damages nerves. The carpal tunnel is a structure that is located at the transition between the forearm and the palm of the hand.
There, a ligament (retinaculum flexorum) stretches from the ball of the thumb to the ball of the little finger. This band of connective tissue forms a kind of roof over a hollow, the base of which are the carpal bones. Tendons and nerves that lead to the muscles of the fingers run through the resulting channel. In carpal tunnel syndrome, this canal is too narrow, so that the nerves are squeezed and a nerve conduction disorder occurs.
The median nerve that runs there, which is one of the most important hand nerves and innervates the thumb, index and middle finger, is particularly affected. Carpal tunnel syndrome is one of the most common nerve compression disorders. It affects women more often than men, usually occurs in midlife (between the ages of 40 and 60) and can be bilateral or unilateral.
The cause of carpal tunnel syndrome is always a narrowing of the space in the carpal tunnel. Various triggers for this amount of space are known, but often there is no precise indication of the development of carpal tunnel syndrome.
A distinction is made between systemic and mechanical causes. Systemic reasons are diseases of the whole body that trigger carpal tunnel syndrome. These include kidney and metabolic diseases, which cause deposits in the carpal canal and narrow it. It is also known that carpal tunnel syndrome occurs in rheumatoid arthritis and arthrosis as well as during pregnancy.
Mechanical causes are processes in the wrist that cause the amount of space, such as tumors, broken bones or swelling during tendonitis. A particular strain on the wrist through professional activities is also considered a trigger. In most cases of carpal tunnel syndrome, however, no precise cause can be identified.
Symptoms, Ailments & Signs
The core symptom of carpal tunnel syndrome is abnormal sensations in the hand, especially in the first three fingers and the palm of the hand. Typical sensory disturbances are tingling, a shooting electrified sensation, pain and numbness. The symptoms are often bilateral.
In the early stages, the pain occurs or intensifies mainly during the night. A very characteristic symptom of carpal tunnel syndrome is the sudden awakening from night sleep – brachialgia paraesthetica nocturna. Upon waking, patients then experience a vague sensation of swelling and notice tingling and stiffness in their fingers.
You may also have the feeling of “fallen asleep” hands. Shaking the hands, often reflexively, can alleviate these symptoms; Massaging also provides temporary relief. In addition to the nocturnal complaints, in the advanced course of the disease there is also morning stiffness of the fingers and swelling.
At this stage, pain also occurs during the day and can radiate to the entire arm. A general lack of strength or loss of feeling can lead to slight motor deficits and restricted movement of the hands over time. In some cases, the musculature of the ball of the thumb may regress at a late stage of the disease, known as abductor-opponens atrophy.
Diagnosis & History
Carpal tunnel syndrome often begins with sensory disturbances in the thumb, index and middle finger, as these are supplied by the median nerve. Fingers feel numb, tingle as if “asleep” and hurt.
These symptoms usually occur under stress and during the night. They are particularly noticeable when the hand is bent, such as when holding the telephone receiver or the steering wheel in the car. This also explains the nocturnal complaints, because many people unconsciously bend their hand slightly while sleeping.
As the carpal tunnel syndrome progresses, the discomfort increases, occurs permanently and the pain can radiate into the arm. As the disease progresses, the fingers become completely numb and the muscles of the thenar atrophy (wasting away).
The doctor diagnoses carpal tunnel syndrome with the help of various tests, as well as measuring nerve conduction speed and electromyography (measuring muscle activity). Another diagnostic test is wrist x-ray, as this will clearly show the amount of space during carpal tunnel syndrome.
The carpal tunnel syndrome leads to severe restrictions and complaints in the hands. As a rule, this syndrome also needs to be treated directly by a doctor. Failure to treat can result in irreversible consequential damage. As a result, the affected person usually suffers from severe limitations in hand movement, which also significantly restricts the patient’s everyday life and reduces the quality of life.
This leads to paralysis and sensory disturbances in the hands. The typical tingling occurs. Patients also suffer from hand pain, which can also occur in the form of rest pain. The pain at rest often leads to sleep disorders and can thus cause general irritability in the patient. There is also reduced strength in the fingers and reduced resilience of the patient.
The wrist is often reddened. As a rule, carpal tunnel syndrome can be treated relatively well with the help of surgery. There are no particular complications or discomfort. After the procedure, the affected person can use their hand as usual again. Life expectancy is not reduced by carpal tunnel syndrome.
When should you go to the doctor?
If you have persistent sensory disturbances in your hand, you should consult a doctor. If you experience numbness, sensory disturbances or hypersensitivity to stimuli, you should consult a doctor. In the event of symptoms of paralysis, a doctor’s visit is required as soon as possible so that the cause of the symptoms can be determined. Since the symptoms of carpal tunnel syndrome are often underestimated, special attention should be paid to the first signs.
Otherwise, the person concerned is at risk of lifelong impairment with corresponding effects on everyday life and professional life. The first warning signs appear with a tingling feeling in the fingers and hands, with pain or restricted mobility. A doctor’s visit is necessary for medical care to take place. If the discomfort spreads between the individual fingers or in the palm of the hand, a doctor’s visit must be made.
If objects can no longer be held as usual, the level of strength drops and the person concerned can no longer carry out the usual movements, he needs a doctor. Impairments of the musculature as well as existing pain during the night’s sleep should be presented to a doctor for a closer examination. Discomfort during a resting position is considered unusual and indicates an existing medical condition. If the fingers repeatedly fall asleep during the day or if the pain increases when the hand is bent, a doctor’s visit is necessary.
Treatment & Therapy
The treatment of carpal tunnel syndrome depends on the severity and the symptoms. For milder symptoms, anti-inflammatory drugs (cortisone) are administered, either in tablet form or by injection into the carpal tunnel.
It is also advisable to immobilize the wrist at night using a splint. Strenuous movements should be avoided during the day. The use of ultrasound waves also has a soothing effect on carpal tunnel syndrome. However, if the symptoms are already more severe, an operation is usually necessary. Two different techniques are possible, open and endoscopic surgery. Both are usually performed under local anesthesia, the open one also under general anesthesia.
In open surgery, the skin and structures overlying the carpal tunnel are opened and the ligament that forms the roof is severed under overhead vision. With endoscopic surgery, a much smaller incision is made at the end of the forearm and a special device is inserted into the carpal tunnel.
The surgeon uses this to cut the ligament from below. After the wound has healed, the hand should be trained with physiotherapeutic exercises in order to regain full functionality. However, the success of an operation also depends on how far the damage caused by the carpal tunnel syndrome had already progressed.
Outlook & Forecast
The prognosis of carpal tunnel syndrome depends on the existing cause. In the event of an inflammatory process, swelling or broken bones, the prospect of full recovery is usually good. Medical treatment is initiated, which leads to freedom from symptoms within a few weeks or months.
In the case of a tumor or a chronic disease, the prognosis is often worse. The further course of the disease depends on the type of tumor disease, the size of the tumor, its growth and the prospect of a cure. Is there arthrosisbefore, the prognosis is unfavorable. The medical applications focus on curbing the progression of the disease. According to the current scientific and medical possibilities, there is no cure for this chronic underlying disease. If the patient cooperates well and avoids overloading, existing symptoms can be alleviated. Nevertheless, the course of the disease cannot be completely stopped in the case of arthrosis or other chronic diseases.
According to new studies, psychological stability also has an impact on prognosis. The more stress and dissatisfaction there is, the more frequently a persistent course of the disease is observed. Without medical treatment, the patient is at risk of developing a secondary disease. Irreversible damage can occur, which significantly worsens the prognosis and contributes to a reduction in quality of life.
It is not possible to prevent carpal tunnel syndrome, since the causes are often unknown on the one hand and on the other hand lie in existing underlying diseases. In the case of typical symptoms that indicate carpal tunnel syndrome, you should consult a doctor immediately in order to avoid complications or consequential damage.
Carpal tunnel syndrome usually ends with the need for surgical treatment. The surgery eliminates the pain syndrome. As part of the follow-up care, the relevant hand is splinted and the surgical site is covered and cared for with a sterile wound bandage. In order to avoid blood congestion in the fingers and in the hand, the hand should be elevated for the first few days after the operation.
In the further course, follow-up examinations are carried out by the treating doctor. Appropriate wound care with a change of dressing takes place. The splint and bandage can be removed after about three weeks. Patients with carpal tunnel syndrome are then symptom-free after the operation. It is recommended to continue the wound treatment for another four weeks.
This can be done very well by using a wound and scar ointment. For heavier work, the hand is then fully operational after about six weeks. Until then, it should be intensified during the recovery process with the help of physiotherapeutic treatments. In this way, the patient finds his way back to his personal and professional everyday life relatively quickly.
In individual cases, a severe carpal tunnel syndrome has developed numbness in the fingers of the affected hand, which can last permanently or only subside much later. This damage to the median nerve is not medically treatable.
You can do that yourself
If carpal tunnel syndrome is present, it is initially advisable to immobilize the wrist at night using a night splint. Stress should be avoided as much as possible during the day. A support bandage is ideally worn. Anyone who sits at the PC a lot or uses their smartphone regularly should reduce these activities for a few days and incorporate relaxation phases into everyday life again and again. Alternative therapies can also help.
Cold therapy, for example, has proven effective and can be supported at home with cold packs and cool wraps. Wraps with anti-inflammatory medicinal plants such as ginger or cypress are particularly effective. With regard to nutrition, eat as few foods as possible that contain acid. Bland foods such as rice, green leafy vegetables and chicken breast are better suited. Various fruit juices also promote healing and provide the body with valuable minerals, vitamins and antioxidants.
If the symptoms do not go away, an appointment for an operation must be made with the doctor. Rest and protection also apply after the operation. In addition, sufficient hygiene should be ensured in the area of the operation, otherwise infections and other complications can occur. Regular check-ups ensure a positive healing process.