Carpal Tunnel Syndrome (CTS) occurs when there is compression of the median nerve at the wrist joint. There is a space in the wrist called carpal tunnel where the median nerve and 9 tendon passes from the forearm into the hand.

Signs and symptoms
CTS usually affects the thumb, index, middle and one half of the ring fingers resulting in:

• Numbness
• Tingling sensation
• Weakness of the hand
• Pain

Causes
The build of pressure is due to inflammation of the lining of the tendons (tenosynovitis) or fluid retention due to a variety of reasons such as:

• Repetitive use of the hand
• Improper hand or wrist position
• Bone dislocation or fracture
• Pregnancy
• Medical conditions such as hypothyroidism, rheumatoid arthritis or diabetes

Diagnosis and investigations
A detail history of how you use your hands, physical examination, X-ray and nerve conduction study will be able to give a diagnosis.

Treatment Options

1. Lifestyle modification may include losing weight, resting the hand or reducing physical stress on the hand to reduce the swelling within the tunnel. Splinting the wrist at a neutral position at nigh can help reduce the symptoms.
2. Home exercises such as median nerve gliding and tendon gliding exercises help the median nerve to move more freely within the confined tunnel

3. Medication. Your doctor may prescribe non-steroid anti-inflammatory drugs (NSAID) to relieve the pain and swelling. In more severe cases, NSAID or steroid injection can be used to relieve the pain faster.

4. Surgery. When symptoms are severe or conservative treatment has not helped, surgery may be required to enlarge the carpal tunnel. Pressure on the nerve is decreased by freeing the ligament which forms the roof (top) of the carpal tunnel. After surgery, there is still some soreness around the incision site which may last several weeks to months. The symptoms take a few weeks to get better while it may take several months to regain normal strength.

5. Post-surgery physiotherapy is recommended to improve the surgical outcome and your therapist will advise you on the type of exercises to do at the centre and at home.

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