Carpal tunnel syndrome

Carpal tunnel syndrome is the most common compressive neuropathy of the upper limb. It occurs when the median nerve becomes trapped as it passes through the carpal tunnel, a narrow channel at the base of the wrist formed by the carpal bones and the transverse carpal ligament.

Carpal tunnel symptoms

• Tingling and numbness in the thumb, index, middle and part of the ring finger
• Night-time pain or cramps that wake the patient from sleep
• Progressive loss of grip strength, particularly during pinching activities
• Clumsiness when handling small objects (buttons, coins)
• A sensation of swelling in the fingers without visible inflammation

Causes and risk factors

Carpal tunnel syndrome can arise from multiple factors: repetitive manual activities, hormonal changes (pregnancy, menopause), diabetes, rheumatoid arthritis, previous wrist fractures or anatomical predisposition. It is more common in women and in individuals over the age of 40.

Diagnosis

Diagnosis is based on clinical examination (Phalen and Tinel tests) and confirmed by electromyography (EMG), which measures nerve conduction velocity. In certain cases, ultrasound may be used to assess nerve swelling and provide additional information.

Non-surgical treatment

In the early stages or in mild cases, night splints, activity modification and corticosteroid injections may be considered. These measures provide temporary symptom relief but do not address the underlying cause if the compression is significant.

Carpal tunnel surgery

When non-surgical treatment is insufficient or electromyography indicates moderate-to-severe compression, carpal tunnel release surgery is the treatment of choice. It is an outpatient procedure performed under local anaesthesia. The operation involves dividing the transverse carpal ligament to decompress the median nerve.

Recovery

Patients typically notice improvement in tingling within the first few days. The hand can be used for light activities immediately. Full recovery of grip strength usually occurs within four to eight weeks. Regular follow-up appointments are arranged to ensure a favourable outcome.