Putting Carpal Tunnel Syndrome (CTS) to Rest

man's hand gripping steering wheel

Contributor: Brad Pierce, MD

We’ve all known someone who has suffered from carpel tunnel syndrome (CTS). With the many demands we place on our hands throughout our lives, it is a fairly common condition that affects the hand and wrist.

The carpal tunnel is a narrow canal comprised of a number of carpal bones in the wrist and a tight ligament spanning the bones. Within the tunnel are nine tendons that flex the fingers and thumb, and the median nerve.

When the median nerve is compressed or pinched it causes typical symptoms of CTS, including:

  • numbness
  • tingling
  • pain

In Orthopaedics, CTS occurs at a rate of one to three cases per 1,000 patients each year. The risk of developing CTS is associated in part, with a number of factors, including:

  •  genetics
  •  medical issues
  •  social issues
  •  vocational work
  •  demographics

No specific cause has been identified, but symptoms are usually intermittent and associated with certain activities, including:

  •  repetitive activities at work or at home
  •  driving
  •  reading the newspaper
  •  hobbies

People with CTS often experience nighttime symptoms that awaken them. The pain can be relieved by shaking the hand/wrist or hanging the hand over the bed. Initial management typically consists of nighttime splinting of the wrist(s) in an attempt to calm any increased pressures in the carpal tunnel when the wrist is flexed or extended during sleep. 

Treatments for CTS include stretching exercises, occupational therapy and anti-inflammatory medications.  Further non-surgical management may consist of steroid injection into the carpal tunnel which has been shown to be therapeutic. Injections may also be beneficial prior to surgical management that needs to be delayed.

The American Academy of Orthopaedic Surgeons, as recently as 2010, released a recommendation that nerve testing be conducted if surgical intervention is considered. Patients who have severe findings on their nerve tests, or who have failed conservative management are also recommended by the Academy to undergo operative decompression of the nerve at the wrist.

Surgical intervention has provided high initial success rates–greater than 90 percent in fact– with low rates of complications. And surgical intervention has been found to halt any permanent sensory or functional loss. 

If you are suffering from CTS, see an orthopaedist and discuss your treatment options. Over time, surgery may be the best route to permanent relief.

To schedule an appointment with Dr. Pierce or any of hand specialists, please call 440.312.6242.

  • SarahE

    I find this behind the times. I thought it had been established that Neurology should handle fibro vs Rheum. Also, pain is not the only symptom, and is sometimes not the worst symptom. Behavioral treatments may benefit some patients, but I find the outdated notion that fibro patients have mental disorders, and that it’s triggered by trauma, to be distressing. I’m surprised CC is not well versed in this.

    • Dillonvale1964

      Am i missing something? Where in this article does it say fibro patients have mental disorders? I read it twice and never got that impression. I think you are bringing your own biases to your analysis. You’re seeing judgement where is none.

  • Greg

    I enjoyed your article & having all of that expertise is a wonderful thing, but what does someone do that is in a lot of pain, but they have no employment, income, or insurance. What can/do you recommend for them?

  • PPD

    I had a trainer ease me up to where I am in exercise today. Regular exercise and yoga keep my stiffness at bay however the pain and soreness NEVER goes away. The endorphins do help with forgetting how bad you feel but when weather exacerbates your symptoms there is no pill or cure for it. I find it unfair to state that people with Fibro have mood disorders and anxiety. It is the fibro that causes this, it is NOT underlying. See how you’d feel if you have a function to attend and you suddenly get hit with a stiff neck or a migraine… even GOOD stress can trigger your symptoms….

  • OHHope

    I have real concerns about the information in this article. I believe that many people who respond to most of the treatments mentioned here are not actually dealing with fibromyalgia. I believe the fibro diagnosis has now become a catchall for hard-to-diagnose circumstances, or as an easy out for doctors who don’t have the experience or the time for a proper diagnosis. I am grateful for a family doctor who trusted my experiences, admitted it was beyond his expertise, and referred me to a specialist. That specialist acknowledged that there wasn’t much he could do for me, but tried what treatments he could to get me as functional and comfortable as possible, and then kept me informed on the latest research and trials. He never gave me false hope, and certainly never minimized my pain or my symptoms.

    • Dillonvale1964

      Are you a physician? How do you know the difference? Have you studied this topic extensively? Have you seen and examined multiple people with fibro that provide you with this perspective? Or this based on your own unique experience?

  • Pearl

    I have Fibro and CFS the fatiigue is the worse unable to even get myself to doctor appt.

    • loni54

      I agree dear. Between the Fibro Fog and the flu-like symptoms of CFS it is very challenging. Does this Dr. do all these things she recommends when she comes down with the flu? Probably not. Why then should her expertize advice us to.

  • HollyK

    I was told 40 yrs. ago (before it was the in thing) by a wonderful GP that I had fibro. and by every Dr.since then. I have mostly suffered in silence just because people seem to think it is something only neurotic people get. I managed to have a teaching career and raise 4 kids and do lots of other things but I still wake up everyday feeling like the tin man. I have utmost empathy for others with this disease.

  • Gina Carvajal-Martin

    I too agree this is way behind the times. Yes exercise endorphins elevate your mood somewhat but my pain is always there. From a7 to a 10. Depression comes from not being able to pick up my 40 lb 6 year old at the age of 42, constant cortisone injections, nerve block procedures in my my neck and back, facet procedures, pt, med after med after med, neurologists for headaches, gastroenterologists for IBS and chronic gastritis and acute pancreatitis and gets. Rheumatologist for pain and anxiety from the inability to work. As well as therapy to cope. Antidepressants don’t touch my pain and my family thinks I’m making this up for attention! Tell me what you would do and how you would feel?

    • peonies@pearls

      Gina – Fibromyalgia is very frustrating. You need to find the right doctor…one who will explain to your family that this is not a psychological condition and that you are not making this up for attention. Their lack of empathy isn’t helping you at all. Then, address each symptom….and hopefully, that will take care of the depression resulting from the onslaught of overwhelming symptoms. For the pain, try following a non-inflammatory diet (or even a vegan diet…which would possibly address your IBS as well). Also, think about getting a regular massage. Also, exercise in moderation on a regular basis. Think more holistically to dealing with fibromyalgia. Have you tried acupuncture? Make sure you are getting enough magnesium…as low magnesium levels can affect levels of muscle pain. A good supplement would be a combination of Vitamin D, magnesium, calcium, and zinc. Also, try to use more tumeric and ginger in your diet and supplement with them as well. Have your vitamin B12 levels checked. Be very careful about prescribed medicines…as they can often cause side effects that require additional medications. For stomach problems, look to dairy and gluten. Even people with RA find that eliminating dairy helps with pain and worsening of one’s condition. You could have allergies to other foods as well…but, dairy and gluten are the biggest offenders. So to sum things up…try to heal yourself from within. Keep a journal and see what foods and situations seem to make you worse. Try to get to sleep by 10pm and get on a regular sleep schedule. Exercise moderately….walking or bike riding. Get out in the sun for a bit. Find an activity you love to serve as a distraction……painting, an instrument, photography, crafting, etc. Meditate and use deep breathing in stressful situations. Eat the healthiest diet possible….lots of greens, other veggies, fruits, legumes, nuts ….think rainbow colors. Our diets are so important. “The food you eat can either be the safest and most powerful form or medicine, or the slowest form of poison”. Try all of these things and hopefully you will be able to wean yourself from Western medicine (which is ill-equipped to handle fibromyalgia). Warm hugs and all the best to you.

      • Marie

        I am on the least meds since I was diagnosed with this and several other diseases. I go to Ohio Rehab in North Canton and get infusions of Lidocaine to help with Fibro. Also I have found a wonderful all natural cream to apply when in severe pain and it helps so much. The cream is Topricin and I get it online. I have given samples to many people with muscle pain and it works for them too. If I didn’t have meds and other ways to ease my pain, I would be bed ridden. Hope this info helps someone.

  • amy

    This article is a very poor, generalized, vague attempt to describe not only symptoms, but also ‘relief’ that is available. Pathetic, actually. For those with severe, widespread, and very active flares, this offers no real insight or advice. No, exercise does NOT lessen any pain, or help with restful sleep. No, depression and anxiety is not an underlying symptom, it is CAUSED by being unable to do even the most basic, everyday chores and activities, being judged by those around you who do not fully believe, or think you must be exaggerating, or worse…just being lazy- and this is an overwhelming amount of emotional obstacles to deal with for anyone. Especially for those with the worst symptoms, I believe, which is the CRUSHING FATIGUE AND EXHAUSTION, that makes every limb feel as

    • Dillonvale1964

      I am frustrated when people take their own personal experiences and generalize that this must be the case for EVERYBODY. Perhaps exercise does not lessen your pain, but that doesn’t mean it can’t work for others. Whether depression and anxiety are underlying symptoms or caused by something is splitting semantic hairs.

      Finally, yes, this is a general article, but there is only so much you can do in an article online. Nothing takes the place of personal interaction with a knowledgeable, compassionate and creative physician. Using loaded words like “pathetic” do not help your cause. It makes you sound irrational and less believable. One can disagree with something without such uncivil language. I am sure you would not use those kinds of words if you were speaking directly with somebody. Why do it online? Nothing.

    • Teresa Barnes

      Exactly! Thank you for this post!

  • amy

    if it weighs hundreds of pounds. Anyone who has had the flu, when your entire body hurts and you have trouble with basic functioning…this is what it feels like. Except it comes and goes any time, for however long it lasts, and it can Rob you of so many of life’s activities and occasions that you wouldn’t have missed for the world if you had any control. For those with family, spouses, and children that aren’t understanding and informed, it is only magnified then with guilt and self-blame, even when your rational self knows this is not within your power to control, when you’re exhausted and in chronic pain it is very difficult not to resort to pity parties and depression, and anxiety. The very best advice would be to first and foremost, STAY AWAY, as much as possible from anyone who treats you with anything less than acceptance and understanding. Yes, for many this will mean most of the people you know, unfortunately. But until you are away from the negativity, you will be unable to come to acceptance within yourself. Until you can learn to accept, and then love yourself IN SPITE of everything you cannot do, you’ll never reach the place where you discover the things you can do, and develop into a loving, accepting person, who has learned the hard way not to judge anyone else, because everyone has their own story, their own journey, and their own struggles. Just like I dislike the judgment from those who have no idea what I’ve been through, I will do my very best to not then turn around and judge anyone else, when I have no idea what they have been through. Do your best to learn to love yourself, with your limitations and obstacles, and you may find those gifts that only you have to offer the world. :-)

  • Sarah

    Good luck taking charge of it! Until we know more about the causes, we’re up a creek without a paddle. And, I agree…any associated mental disorders are probably a result of the symptoms and the costs…I just quit a doctor and a ended a friendship because they doubted my descriptions of chronic fatigue..as did social security. I didn’t chose this…it chose me. And, I’m not happy about it.

  • Brenda Smith

    I have had Fibromyalgia since 1995. The Rheumatologist has ordered various anti depressants that are supposed to help with the pain and help me sleep. For me they are useless, they don’t help any of my symptoms at all. I have also tried Lyrica and Neurontin at different times over the years, and they don’t help me either. I don’t know what else to do for the pain I have. My Rheumatologist is great, but I am tired of trying medications that don’t help.

    • Devonna Shaffer

      I have suffered with fibro for 3 yrs now but only the last yr so bad i can’t do the everyday things…I’ve been taking GABAPENTIN for over a month now and it helps with the pain and energy…i love it and suggest it

  • Kelly King

    Dillonvale1964 Did you write this article? You seem very defensive! I have had fibro since 1999, i think i got it after w very bad car wreck & 3 surgeries. I also have CFS & DDD. I agree the article doesn’t even begin to cover how severe fibro is & how complex. & any depression or anxiety in my case is caused by years of severe chronic pain & fatigue not the other way around. Hope all of you find some relief.

  • Gail

    I live by the Nike moto I just do it. Yes am in horrible pain but I fight through it.