Carpal Tunnel Syndrome (CTS) Treatment in Delhi, India

To understand carpal tunnel syndrome, it's essential to first grasp the anatomy and function of the carpal tunnel itself. The carpal tunnel is a passageway in the wrist formed by the carpal bones on the bottom and sides and a ligament on top. Inside this tunnel, runs the median nerve (alongside the tendons) that provides innervation to the thumb, index, and middle fingers, as well as part of the ring finger. When the structures within the carpal tunnel become irritated or swollen, they compress the median nerve leading to symptoms such as pain, numbness, tingling, or weakness in the hand and wrist. These sensations often affect specific fingers, excluding the little finger. This condition is known as carpal syndrome.

The causes of CTS can be diverse, ranging from repetitive hand use and underlying health conditions to occupational factors and wrist injuries. Here are some of the most common ones.

• Narrowing of the carpal tunnel: This can happen due to inflamed tendons, swelling, or other factors, putting pressure on the median nerve.
• Frequent hand use: Activities involving repetitive motions, vibrating tools, or tight grips can increase the risk of CTS. 
• Underlying health conditions: Pregnancy, diabetes, arthritis, and thyroid problems can contribute to CTS development.
• Trauma: Wrist injuries like fractures or dislocations can also be a cause.
• Occupational factors: Certain professions with repetitive hand movements, such as assembly line workers, cashiers, and musicians, are at higher risk.

Understanding the risk factors associated with carpal tunnel syndrome can be crucial in identifying individuals who may be more susceptible to developing the condition. Additionally, implementing preventive measures and early interventions can help manage or reduce the impact of these risk factors on the development of CTS.

Medications

Certain medications may contribute to the development of carpal tunnel syndrome. This can include drugs that cause fluid retention, leading to increased pressure within the carpal tunnel.

Anatomic factors

Anatomic factors refer to the physical characteristics of the hand and wrist. Some individuals may have a naturally smaller carpal tunnel or variations in the anatomy that predispose them to CTS.

Inflammatory conditions

Inflammatory conditions, such as rheumatoid arthritis, can contribute to the inflammation of the tissues within the carpal tunnel, leading to compression of the median nerve.

Nerve-damaging conditions

Conditions that directly damage or compress nerves can increase the risk of carpal tunnel syndrome. Examples include injuries, tumours, or systemic conditions affecting nerve health.

Workplace factors

Certain occupational activities that involve repetitive hand movements, forceful gripping, or exposure to vibrations can contribute to the development of carpal tunnel syndrome. Prolonged and repetitive use of the hands and wrists may lead to irritation and compression of the median nerve.

Obesity is considered a risk factor for carpal tunnel syndrome. Excess body weight may contribute to increased pressure on the median nerve and other structures within the carpal tunnel.

Body fluid changes

Changes in body fluid balance, such as during pregnancy or with conditions causing fluid retention, can lead to increased pressure within the carpal tunnel. This heightened pressure may contribute to the compression of the median nerve.

Other medical conditions Various systemic conditions, such as diabetes,hypothyroidism, and certain metabolic disorders, may increase the risk of carpal tunnel syndrome. These conditions can affect nerve function and contribute to the development of CTS symptoms.

The symptoms of Carpal Tunnel Syndrome (CTS) can be categorised into four main types:

1. Sensory

• Numbness: This usually affects the thumb, index, middle, and half of the ring finger.
• Tingling: Often described as a pins and needles sensation.
• Burning: Can feel like a hot or prickly sensation in the affected area.
• Difficulty distinguishing hot from cold: In severe cases, touch sensitivity can be affected.

2. Motor

• Grip weakness: Can make it difficult to hold objects, open jars, or type.
• Difficulty making a fist: Weakness in the thumb muscles can make it hard to close your hand completely.
• Clumsy hand movements: Difficulty performing fine motor tasks like writing or buttoning clothes.

3. Pain

• Dull ache: Can be localised in the hand, wrist, or forearm.
• Sharp pain: Can be sudden and intense, triggered by specific movements.
• Nighttime pain: The pain may be worse at night, especially when the wrist is in a flexed position.

4. Other

• Hand swelling: In some cases, the affected hand may become swollen and puffy.
• Muscle wasting: The muscles at the base of the thumb may shrink over time if the condition is left untreated.
• Changes in skin texture: The skin on the affected hand may become dry, scaly, or discoloured.

It's important to note that the severity and specific symptoms of CTS can vary from person to person. Additionally, the symptoms may initially appear only at night or after prolonged hand use but can progress to become more persistent and interfere with daily activities.

If you are experiencing any of these symptoms, it is important to consult with a carpal tunnel syndrome specialist for proper diagnosis and treatment. Early intervention can help prevent further damage and improve your overall hand function.

The doctor will go through the history given by the patient and then conduct specific special tests to determine the presence of carpal tunnel syndrome in the patient:

Physical examination: The doctor does a physical exam of the patient by checking the strength of the muscles in hand. Special tests like Bending the wrist, tapping on the nerve with a hammer or simply pressing on the nerve can trigger symptoms in various patients.

 X-ray: An <f="https://www.maxhealthcare.in/technology/x-ray">X-ray of the affected wrist helps in the exclusion of other causes of wrist pain, such as arthritis or a fracture. However, X-rays do not help make a proper confirmation of this condition.

Electromyography: This test provides the measurement of tiny electrical discharges produced in muscles. The doctor performs the procedure by penetrating a thin needle electrode into specific muscle groups to access the electrical activity during the contraction and relaxation of muscles. This test can detect the amount of damage to the muscles controlled by the median nerve and rule out other conditions accordingly.

Nerve conduction study: It is a variant of electromyography. Here two electrodes are taped to the skin, and a small shock is passed through the median nerve to find out the response whether electrical impulses are reduced in the wrist area. Apart from this condition, this test is used to rule out any other conditions. 

Tinel’s Sign: Tinel’s Sign is a diagnostic test for carpal tunnel syndrome that involves tapping or lightly percussing the median nerve at the wrist. A positive Tinel’s Sign is indicated when this percussion elicits tingling or a "pins-and-needles" sensation in the distribution of the median nerve, providing valuable information to healthcare professionals assessing the presence of carpal tunnel syndrome.

Wrist Flexion Test (Phalen Test): The Wrist Flexion Test, also known as the Phalen Test, is a diagnostic manoeuvre for carpal tunnel syndrome. In this test, the patient flexes their wrist by pressing the backs of their hands together in a prayer-like position. If symptoms such as tingling or numbness develop within one minute, it is considered a positive Phalen Test, suggesting compression of the median nerve within the carpal tunnel. These diagnostic tests are commonly employed by healthcare providers to aid in the clinical evaluation of individuals with suspected carpal tunnel syndrome.

Several treatment options are available for carpal tunnel syndrome, depending on the severity of the patient's symptoms and individual needs. Here is a summary of the most common approaches:

Nonsurgical Treatments

• Wrist Splinting: This is often the first line of treatment and involves wearing a splint, typically at night, to keep your wrist in a neutral position and prevent the median nerve from being compressed. Splinting can help reduce pain, tingling, and numbness, especially during sleep.
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): These over-the-counter medications, such as ibuprofen or naproxen, can help reduce pain and inflammation associated with carpal tunnel syndrome. However, they do not typically address the underlying cause of the condition.
• Corticosteroid Injections: Injections of corticosteroids, such as cortisone, directly into the carpal tunnel can provide faster and more potent relief from pain and inflammation than NSAIDs. However, the effects of injections are often temporary and may need to be repeated over time.
• Activity Modification: Avoiding activities that aggravate your symptoms, such as repetitive hand use or forceful gripping, can help prevent further nerve damage and alleviate existing symptoms.
• Vitamin B6: Although research is inconclusive, some studies suggest that taking vitamin B6 supplements may help improve symptoms in some people.
• Physical Therapy: A physical therapist can teach you exercises to strengthen the muscles in your hand and wrist, improve flexibility, and reduce pain.

Surgical Treatment

Carpal Tunnel Release Surgery: This is the one of the most effective treatment options for severe cases of carpal tunnel syndrome that do not respond to nonsurgical treatment. The surgery involves cutting the ligament that compresses the median nerve, allowing it to decompress and relieve symptoms.

Other Options:

• Treating underlying conditions: If your carpal tunnel syndrome is caused by an underlying medical condition, such as diabetes or rheumatoid arthritis, treating the underlying condition may also help improve your carpal tunnel symptoms.
• Lifestyle changes:< Maintaining a healthy weight and avoiding smoking can help reduce your risk of developing carpal tunnel syndrome or improve your symptoms if you already have it.

The recovery from carpal tunnel surgery usually takes several weeks to months. However, recovery may take longer if the nerve has been compressed for an extended period. The recovery process involves splinting of the wrist and getting physical therapy to strengthen and heal the wrist and hand. Treatment of carpal tunnel syndrome early with daily physical therapy sessions along with lifestyle modifications results in significant and satisfactory long-term improvement and eliminates symptoms as well.

In rare cases, untreated carpal tunnel syndrome can lead to permanent nerve damage, disability, and loss of hand function.

Can I perform daily activities with Carpal Tunnel Syndrome(CTS)?

This depends on the severity of your symptoms. Some people can manage daily activities with minor adjustments, while others may require ergonomic modifications or assistive devices.

Does CTS always require surgery?

No, most cases of CTS can be managed with non-surgical treatments like splinting, medication, or physical therapy. Surgery is usually only considered when other options fail to provide relief.

How can I prevent CTS from worsening?

Taking breaks from repetitive hand movements, practising good posture, and maintaining a healthy weight can help prevent CTS from progressing.

How do I know if my hand pain is just a sprain or CTS?

While both can cause pain, CTS typically involves additional symptoms like numbness, tingling, and weakness. If you're unsure about the cause of your hand pain, consult a carpal tunnel syndrome doctor in Delhi.

Can CTS affect my other hand?

Yes, CTS can affect both hands, although it may not develop simultaneously in both.

Can I use a heating pad or ice pack for CTS pain?

Both can provide temporary pain relief. However, consult your doctor for specific instructions and precautions.

Are there any natural remedies for CTS?

While some people find relief with natural remedies like turmeric or vitamin B6, there's limited scientific evidence to support their effectiveness. Consult your doctor before trying any natural remedies.

How long does it take for CTS to recover after treatment?

Recovery time varies depending on the severity of the case and the treatment chosen. Consult your doctor for a more specific estimate.

Can stress aggravate CTS symptoms?

Yes, stress can contribute to muscle tension and inflammation, potentially worsening CTS symptoms.

Is it safe to exercise with CTS?

Yes, but it's important to choose exercises that don't aggravate your symptoms. Consult a physical therapist or doctor for safe and beneficial exercise options.

Can CTS be caused by using a phone too much?

While excessive phone use alone may not be enough to cause CTS, it can contribute to the development of symptoms, especially when combined with other risk factors like repetitive hand movements.

Are there any specific hand stretches or exercises that can help with CTS?

Yes, specific stretches and exercises can help improve flexibility, strengthen muscles, and reduce pain associated with CTS. However, it's crucial to consult a healthcare professional or physical therapist for personalised recommendations to avoid further injury.

Does wearing wrist braces all the time help prevent CTS?

While wrist braces can be beneficial in certain cases, wearing them constantly can weaken the muscles in your hand. It's recommended to use them only as directed by a doctor and to follow a comprehensive treatment plan.

Can CTS cause carpal tunnel release surgery to fail?

While rare, complications like scar tissue formation or nerve damage can occur after carpal tunnel release surgery, potentially causing symptoms to return.

How can I tell if CTS is affecting my sleep?

If you wake up with numb or tingling hands, difficulty gripping objects, or pain that disrupts sleep, it could be a sign that CTS is impacting your sleep quality.

Are there any alternative treatments for CTS besides surgery and medication?

Depending on the severity of your case, alternative therapies like acupuncture, massage therapy, or yoga might offer some relief. However, consult with your doctor before starting any new treatment.

How can I manage CTS symptoms while travelling?

Taking frequent breaks, stretching your hands, and using ergonomic travel accessories like a supportive wrist rest can help manage CTS symptoms while on the go.

Can CTS cause headaches or other seemingly unrelated symptoms?

While less common, CTS can sometimes cause radiating pain in the arm, shoulder, or even headaches due to nerve compression and muscle tension.

How can I modify my work environment to prevent CTS?

Ergonomic adjustments like using a keyboard tray, a mouse with good wrist support, and proper chair height can significantly reduce your risk of developing CTS from work-related activities.

What are the latest advancements in CTS treatment?

Minimally invasive surgical techniques, laser therapy, and ultrasound treatments are some of the emerging advancements in CTS treatment offering shorter recovery times and potentially less pain.

Reviewed by Dr. Vikas Gupta, Director - Orthopaedics and Head - Hand & Shoulder Surgery, Orthopaedics & Joint Replacement, Arthroscopy & Sports Injury on 22-Jan-2024.