Carpal tunnel syndrome (CTS) results from compression of the median nerve within the carpal tunnel in the wrist. This results in symptoms of numbness and tingling, pain and weakness. Patients often complain of their hands falling asleep and dropping objects. Nighttime symptoms that wake the individual are quite common. The pain can sometimes be quite severe and can radiate not only into the hand and fingers but up into the forearm and even shoulder and neck area. This can sometimes create confusion as to the diagnosis.
The first line investigation includes electrophysiologic studies called nerve conduction studies and EMG (NCV/EMG). NCV/EMG is essential not only to provide an accurate diagnosis but also to assess the severity of the carpal tunnel syndrome and to rule out other causes for hand and arm pain, numbness and tingling. Other conditions that can cause similar symptoms include cervical spine disease, diabetic neuropathy, Multiple Sclerosis, brachial plexopathy as well as other conditions. An accurate diagnosis is essential in order to recommend effective treatment.
Physical and occupational therapy with the use of wrist splinting is one of the best evidence based conservative treatments for carpal tunnel syndrome and most patients with mild to moderate carpal tunnel syndrome as determined by NCV/EMG respond to conservative treatment within two to four weeks. Steroid injections into the carpal tunnel may also be of some benefit if conservative treatment fails.
Surgical intervention should only be considered in those who have failed conservative treatment or those who have severe carpal tunnel syndrome as categorized by NCV/EMG. In this particular population of patients, surgery has a high success rate.