Neurological Disorders: Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a neurological disorder and results from damage to the median nerve within the carpal tunnel at the wrist region. It presents with hand & finger symptoms. A neurologist frequently involves in the management of CTS.

Carpal tunnel is a tunnel like space in the wrist area surrounded by ligaments (connective issue structure) and bones. Several tendons pass through it from the forearm to the wrist area. Median nerve too passes through this canal, and supplies the hand. It is a narrow area with just enough space for these structures and anything compromises this space can result in the damage to the median nerve.

There are myriad causes for median nerve damage within the carpal tunnel and by definition you call it as CTS only if the damage is idiopathic (cause is not found). If you know the cause then you associate the nerve injury to that cause rather than call it as CTS.

Exactly what triggers CTS is still not clear. It seems there is some genetic predisposition. There is also a suggestion that it is occupational but it was never proved. It could be a combination of genetic susceptibility and occupational. Jobs requiring repetitive hand or wrist movements are generally incriminated for CTS e.g frequent typing.

• Pain
• Numbness
• Burning sensation
• Generally more symptoms in the night
• Tingling (pins& needles)
• Hand weakness
• Muscle wasting etc

The symptoms usually correspond to the region and structures supplied by the median nerve. The sensory fibers in the median nerve supply the thumb, index, middle and about ½ of the ring fingers. Few hand muscles are also supplied by this nerve.

Diagnosis is done based on characteristic clinical history & examination findings and this is generally followed by an EMG/NCS (electromyography and nerve conduction studies) of the hand.

If secondary causes of median neuropathy at the wrist are suspected then relevant investigations are performed and some of these tests include thyroid tests, serum lipid profile, rheumatoid factor, blood sugar etc.

For mild cases conservative treatments are generally tried first and this includes wrist brace, occupational therapy, avoiding excessive repetitive movements at the wrist etc.

For moderate to severe cases carpal tunnel release surgery is usually recommended.

Symptomatic management of carpal tunnel syndrome includes NSAIDs (non steroidal anti inflammatory drugs) like ibuprofen, nerve pain pills like gabapentin.