Carpal tunnel syndrome is a result of compression of the median nerve in the carpal tunnel at the wrist. This nerve pressure injury causes a variety of symptoms, including tingling in the hands. The most common symptoms include pain, sensory disturbances such as tingling and numbness, and weakening of the hand and finger strength. In many cases, the symptoms can be alleviated through targeted exercises.
Compact & concise
The carpal tunnel, also called the carpal canal, is located on the inside of the wrist and is formed by the carpal bones and a tight ligament, the retinaculum flexorum. It serves as a passage for the median nerve and the flexor tendons of the hand.
Carpal tunnel syndrome (also known as CTS) occurs when the median nerve becomes trapped at the wrist. This often leads to pain, loss of sensation, numbness, loss of strength and muscle atrophy in the hand and fingers.
Since 2015, carpal tunnel syndrome has been recognized as an occupational disease.
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Do you suffer from numb fingers at night or do you have difficulty holding a cup? From the first signs to the advanced stages of carpal tunnel syndrome, you will learn more in the next section “Symptoms of carpal tunnel syndrome”.
In carpal tunnel syndrome, the median nerve in the wrist area is compressed or damaged. This nerve supplies various areas of the hand and, if damaged, can cause tingling, numbness, paralysis, finger problems, swelling, dysfunction or even paralysis. Here we offer an overview of the anatomical structures in the wrist area, where the carpal tunnel, tendons and nerve run.
Interesting to know: Carpal tunnel syndrome has been recognized as an occupational disease since 2015 and is defined as follows:
“Pressure damage to the median nerve in the carpal tunnel (carpal tunnel syndrome) due to repetitive manual activities involving flexion and extension of the wrists, increased force exerted by the hand or hand-arm vibrations.” 1)
Between 3 and 10 percent of the German population suffer from such nerve entrapment. It occurs mainly between the ages of 40 and 70, with women being significantly more frequently affected.
Carpal tunnel syndrome is often abbreviated as KTS or “C”, i.e. carpal tunnel syndrome or CTS. The carpal tunnel is the connection between the forearm and the hand and is limited by the carpal bones.
The carpal tunnel is formed by the carpal bones on the inside and the carpal ligament (retinaculum flexorum), a strong band of connective tissue that lies over the bones. At the level of the wrist, it runs across the carpal canal to protect tendons and nerves. The carpal ligament ensures that these structures stay in place.
The median nerve runs from the shoulder to the fingers and controls muscle movements and the sense of touch. Together with nine flexor tendons, it passes through the carpal tunnel. The tendons of the finger flexor are surrounded by tendon sheaths that can absorb fluid and swell. Tendon sheaths are sheaths around the tendons that are filled with synovial fluid.
The carpal tunnel is a naturally constricted space that is extremely vulnerable to overload, pressure damage, and neurological injury.
However, the carpal tunnel itself is not rigid. The carpal bones, which together with the carpal ligament form the canal, are also not rigid. Different hand movements change the depth of the carpal tunnel.
The carpal ligament, which runs over the carpal tunnel in the wrist, forms a kind of lid and ensures that there is different amounts of space in the carpal tunnel depending on the hand movement.
Carpal tunnel syndrome occurs when the median nerve is constantly irritated or damaged by repeated wrist movements, flexion or extension. However, the space in the carpal tunnel can also increase for other reasons, such as fluid retention due to diabetes, hormonal changes, inflammation in rheumatic diseases or after fractures near the wrist that lead to the formation of callus (scar tissue formed by bone).
Overview:
As the disease progresses, the following symptoms may occur later:
Are you at risk for carpal tunnel syndrome due to your job? Find out in the causes section!
The symptoms of carpal tunnel syndrome often begin at night and later worsen during the day.
Most people suffering from carpal tunnel syndrome report that their hand initially falls asleep at night or early in the morning. The feeling often goes away when you shake your hands. Repositioning the hand at night can also initially relieve pain. Some sufferers find relief by holding their hand under cold water.
The symptoms can appear in the thumb, index finger, middle finger and on the thumb side of the ring finger.
If the little finger and ring finger in particular are affected, it could also be the related cubital tunnel syndrome.
Neurological symptoms caused by tingling hands usually begin in the palms of the hands. Later on, the discomfort gradually spreads to several fingers, including the thumb and index finger. Since the median nerve runs to the shoulder, severe shoulder pain can occur. Everyday activities such as making phone calls, reading the newspaper or riding a bike often become increasingly difficult for those affected.
Permanent numbness in the hands leads to loss of dexterity. Many people notice this when doing manual tasks or when buttoning. In extreme cases, the damage to the median nerve is so severe that the muscle of the ball of the thumb, which is supplied by this nerve, continues to atrophy.
Those affected may have difficulty holding a cup at an early age. Due to weakness, loss of touch, limited fine motor skills, sensitivity and muscle atrophy, objects such as cups slip out of the hand unintentionally.
Overview:
Excessive tension is caused by one-sided movement patterns:
The reason for carpal tunnel syndrome is increasing tissue pressure and overloading of the carpal tunnel.
One-sided movements, such as when working at a keyboard, lead to shortening of the hand flexor tendons. This creates high muscular-fascial tension, which leads to swelling of the tendons – the tunnel becomes narrow. The extent of damage to the median nerve is determined by the duration and intensity of pressure in the carpal tunnel.
This pressure impairs blood circulation, making the vessels more permeable. Components of the blood, including immune cells that combat pressure, are released in increased amounts. This increased permeability increases the risk of local inflammation and fluid accumulation in the nerve, which in turn worsens blood circulation.
The pain and discomfort increases in the hands and wrists. In the long term, this can lead to nerve damage.
Rarely, fractures and injuries to the wrist can cause carpal tunnel syndrome.
The pressure in the carpal tunnel increases due to a mismatch between the width of the tunnel and its contents (tendons and nerves).
Certain risk factors cause the tendons and nerves in the carpal tunnel to swell. This includes:
1. Phalen test: In this test, you press the backs of your hands together horizontally for 60 seconds. A positive result is indicated by unusual sensations such as numbness or pain in the wrist area after the time has elapsed.
2. Reverse Phalen test: The palms of the hands are pressed together for 60 seconds. Compared to the Phalen test, this method is less reliable.
3. Hoffmann-Tinel sign: The area of the wrist where the median nerve runs is tapped while the wrists are initially left in a neutral position. The occurrence of pain or sensory disturbances is considered an indicator of carpal tunnel syndrome.
4. Carpal compression test: The hands are in a neutral position while the examiner presses on the median nerve in the area of the carpal tunnel. A positive result indicates that symptoms of carpal tunnel syndrome are triggered or aggravated.
5. Flexion-compression test: Your arms are stretched out on a surface and your palms are facing upwards. The doctor or therapist bends the wrist upwards by 60 degrees and applies pressure to the median nerve in the carpal tunnel area. A positive result is shown by the occurrence of symptoms.
6. Tourniquet test: In this test, a blood pressure cuff is placed around your upper arm and inflated above your systolic blood pressure value. If you suffer from carpal tunnel syndrome, you may experience numbness, discomfort, and pain in the area of the median nerve in your wrist.
The promising treatment alternative is the use of curpal®. This patented medical device offers a non-surgical solution for carpal tunnel syndrome. Through the mechanically generated pressure on the back of the hand, curpal® stretches the carpal ligament on the palm of the hand, which runs transversely from the ball of the hand to the edge of the hand.
This widens the carpal tunnel and gives the nerve more space. The pressure that caused pain and discomfort subsides. The use of curpal® is an effective method to prevent the progression of carpal tunnel syndrome. However, there are other preventative measures that patients can take. This includes regular wrist stretching and extensions to improve the flexibility of hand and finger movements. Wearing special wrist supports can also help reduce pressure on the median nerve in the carpal tunnel.
curpal® offers an innovative and gentle alternative to the conventional treatment of carpal tunnel syndrome. It allows patients to relieve their symptoms and improve their quality of life without having to undergo surgery. You can find more information about curpal® and its application on the official website: https://www.curpal.de/ .
1. German Medical Journal – https://www.aerzteblatt.de/archiv/188575/Karpaltunnelsyndrom-Manuelle-Therapie-ist-ueber-ein-Jahr-so-wirksam-wie-OP
2. Focus.online – https://unternehmen.focus.de/karpaltunnelsyndrom-symptome.html
Carpal tunnel syndrome (CTS) is a condition characterized by symptoms such as tingling, numbness, and other unpleasant sensations in the wrist area. Those affected often complain of symptoms that occur especially at night. The causes of carpal tunnel syndrome can be varied, from diabetes to advanced age.
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