Carpal tunnel syndrome (CTS)

Carpal tunnel syndrome (CTS) occurs when the nerve in the carpal tunnel at the wrist becomes compressed. This leads to tingling and pain and, if left untreated, can result in nerve damage and muscle wasting.

All the information on carpal tunnel syndrome at a glance:

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A woman and a man are out walking with their dog. The woman is wearing a wrist bandage

What is carpal tunnel syndrome?

Carpal tunnel syndrome is what is known as a ‘compression syndrome’ or ‘nerve compression syndrome’. The name comes from the fact that nerves are constricted and compressed. In carpal tunnel syndrome, this affects the median nerve (nervus medianus), which runs through the narrow and inflexible carpal tunnel. Space is limited there, as the tunnel is bounded on three sides by bony structures and a tight ligament (retinaculum flexorum). In many cases, both hands are affected equally.

Prevalence
Carpal tunnel syndrome most commonly occurs between the ages of 40 and 70 and is about twice as common in women as in men. It is very rare in children. People who do physical work are more frequently affected. It is estimated that 3 in every 1,000 people develop carpal tunnel syndrome each year.

Anatomical diagram of the left hand showing the carpal tunnel and the carpal ligament — *Left hand, back of the hand*

Common symptoms of carpal tunnel syndrome

Sensory symptoms and pain

Tingling and prickling sensations in the fingers and palms (mainly at night)
Numbness and hands going numb (mainly at night)
Impaired sense of touch and reduced coordination
Pain in the wrist and forearm at night or in the morning
Pain in the hand when moving it

Motor function and strength

Restricted movement of the thumb
Loss of strength in the hand and wrist
Wasting of the muscles of the thenar eminence (thenar atrophy)

Symptomatic progression of carpal tunnel syndrome

Some people initially experience only mild symptoms for years, which come and go. The majority of those affected have persistent symptoms that worsen over time, particularly following heavy strain, during pregnancy and following arm injuries.

The first symptoms of carpal tunnel syndrome usually occur at night or in the early hours of the morning, as well as after exertion with the wrists bent. The thumb, index finger, middle finger and, in some cases, the ring finger feel numb on the palm side of the hand. Those affected also perceive their hand as feeling cold.

As the condition progresses, the numbness can lead to the hands going numb. This is often accompanied by a tingling sensation or a feeling of pins and needles in the fingers and palms. The pain increases and then occurs spontaneously or even continuously during the day. It can radiate up into the arm or shoulder. Further symptoms include a deterioration in the sense of touch, as well as a loss of fine motor skills and strength in the hand.

In very advanced stages, the fingers may feel stiff and swollen in the morning. Muscle wasting at the base of the thumb may also occur, along with functional limitations and even paralysis.

Causes and risk factors for carpal tunnel syndrome

Although in most cases the actual cause is unknown, there are causes and risk factors for this condition.

Carpal tunnel syndrome can be caused either by excessive tissue within the tunnel or by a tunnel that is too narrow. The latter may be congenital, hereditary or the result of an injury.

The main causes of tissue swelling are:

Injuries near the wrist (e.g. a broken radius or dislocation of the carpal bones)
Rheumatic inflammation or inflammation of the tendon sheaths
Osteoarthritis of the wrist
Chronic kidney failure, particularly where dialysis is required
Fluid retention in the joints and ligaments (e.g. due to thyroid disorders, diabetes or hormonal changes)
Tumours and other growths (e.g. lipomas or ganglions)

The main risk factors for carpal tunnel syndrome are:

Being female, particularly during or after the menopause
Taking oral contraceptives or oestrogens
Pregnancy, breastfeeding
Strenuous activities involving repetitive hand or wrist movements or the use of vibrating tools
Obesity
Alcohol and nicotine consumption

Diagnosis of carpal tunnel syndrome

Clinical examination of the hand

Following the medical history and the resulting suspicion of carpal tunnel syndrome, the range of motion of the wrists provides an initial indication during the clinical examination. The so-called Phalen’s test is positive if, when the wrist is flexed as far as possible towards the palm of the hand, sensory disturbances occur in the fingers for over a minute – a fairly reliable indication of carpal tunnel syndrome. In advanced stages, the muscles of the thumb pad atrophy and those affected are no longer able to bring their thumb to the tip of their little finger. In the Hoffmann–Tinel test, the inner side of the wrist is tapped with two fingers. The Hoffmann–Tinel sign is positive if this causes an unpleasant, almost electric-like pain. Superficial sensitivity is also tested.

A doctor is performing an electroneurography on a blonde woman. To do this, the machine is connected to the patient’s arm. — Electroneurography is used to measure nerve conduction velocity and to detect any nerve damage.

Neurological examination of the hand

An objective diagnosis can be made through a neurological examination involving the measurement of nerve conduction velocity (electroneurography, ENG). The median nerve is stimulated using a weak electrical impulse. If the nerve is damaged, a reduced conduction velocity is observed. In addition, magnetic resonance imaging (MRI) can provide findings to guide further treatment.

Carpal Tunnel Syndrome Self-Tests

Anyone who suspects they may have carpal tunnel syndrome but is still waiting for a doctor’s appointment can carry out a few tests themselves. The Phalen and Hoffmann-Tinel tests can, in principle, also be done at home. You can also check whether you can reach the tip of your little finger with your thumb. For the bottle test, you grip an ordinary bottle with your hand. In advanced stages, this is no longer possible due to the weakening of the muscles in the ball of the thumb. This can help to rule out or confirm your suspicions. If symptoms persist, you should always seek medical advice.

Therapy and treatment of carpal tunnel syndrome

In the early stages: conservative treatment of carpal tunnel syndrome (CTS)

Carpal tunnel syndrome can be treated effectively with conservative methods in the early stages, when symptoms are mild. The aim is to relieve pressure on the nerve and prevent permanent nerve damage. If the symptoms are detected early and the pain is not yet persistent, carpal tunnel syndrome can, in most cases, still be treated by immobilising the wrist at night. In addition to bandages, orthoses are primarily used to immobilise the wrist, e.g. the JuzoPro Manu Xtec Palmar wrist orthosis.

JuzoPro Manu Xtec Palmar – Wrist brace for stabilisation in two directions of movement

Large thumb opening and unrestricted finger movement
Comfort zones in the thumb and forearm areas
Optimal fit thanks to an extra-wide, anatomically shaped aluminium splint
High level of comfort thanks to breathable, moisture-wicking materials
Practical fastening system

Wrist brace for the treatment of carpal tunnel syndrome – JuzoPro Manu Xtec Palmar

Discover the JuzoPro Manu Xtec Palmar

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In addition to immobilisation, anti-inflammatory medication, cold and heat therapy, and ultrasound treatments can help. Other important components of conservative treatment include physiotherapy and exercise therapy with individually tailored exercises.

Advanced stage: Surgery

If the condition is already at an advanced stage and other treatments are not sufficiently effective, surgery may be necessary. It can alleviate the symptoms or make them disappear completely, but it is not without risk.

During surgery, the carpal ligament, which runs along the palmar side of the carpal bones, is severed. This relieves pressure on the median nerve. There are two surgical procedures available:

open surgery (access via an incision (approx. 4 cm) on the inside of the wrist)

endoscopic surgery (access via small incisions on the palm and at the wrist)

Both procedures are equally effective and carry similar risks. Following endoscopic surgery, the scars are slightly smaller, recovery is sometimes slightly quicker, and patients can return to work sooner. The operation is usually carried out on an outpatient basis under local anaesthesia of the hand or arm. The procedure often takes less than 30 minutes.

In most cases, patients are symptom-free after the operation – although, in the event of nerve damage, this may take several weeks or months. Pain often subsides more quickly than sensory disturbances. Nerve damage that has been present for years prior to the procedure cannot be fully reversed. As part of the follow-up treatment, the wrist is usually immobilised using a brace such as the JuzoPro Manu Xtec Palmar. The operated hand should be rested for 2 to 3 weeks. It can bear a full load again after 6 to 8 weeks.

Exercises to manage and prevent carpal tunnel syndrome

Although the first step in managing carpal tunnel syndrome is to relieve pressure on and protect the affected structures, a certain amount of movement is needed to maintain metabolism and healing processes and to prevent muscle atrophy.

A combination of various exercises for muscle relaxation, mobilisation, stretching and strengthening is suitable for this purpose. A qualified physiotherapist can help put together the right exercises and support you in striking the right balance between rest and exercise. Suitable exercises can be performed both once a diagnosis has been made and as a preventative measure.

3 sample exercises:

Whilst standing, place the affected hand, palm down, on a tabletop.
Fully extend your elbow.
Rotate your hand outwards until your fingertips are pointing towards your thigh.
Carefully lean backwards with the shoulder on the affected side.
You should feel a noticeable but bearable stretch on the inside of your forearm and in your wrist.

approx. 2 minutes

Relief in everyday life

If you are prone to carpal tunnel problems, it is advisable to avoid prolonged strain and to relax your hands and wrists in everyday life by regularly bending and stretching them. When working at a computer, it is advisable to adopt a relaxed basic position in which the wrists are neither sharply bent nor overextended. With this in mind, wrist rests and ergonomically optimised keyboards and computer mice are useful aids.