Carpal tunnel syndrome (CTS) is a condition where the median nerve, the nerve that controls the function of some muscles of the hand, is compressed during its passage through the tunnel formed by the wrist bones (carpal tunnel). The underlying cause of most of the cases of CTS is unknown, but it is believed to be associated with an overuse of the hands and repetitive hand activities. The main complaints of CTS are numbness and a burning sensation in hand along with pain.

Certain occupational hazards that is frequently seen earlier in life is not often believed to affect the elderly. Carpal tunnel syndrome is often associated with these activities – like prolonged use of a computer mouse, keyboard and video game controller. However, with an aging population that has become technology savvy and remaining economically active in the senior years, carpal tunnel syndrome can arise in the elderly.

Signs and Symptoms

The chief complaints of carpal tunnel syndrome (CTS) include :

• Numbness, abnormal feelings (paresthesia) like tingling, pricking, burning sensation of the thumb and next two or three fingers (index, middle and part of ring fingers).
• Pain extending from the wrist to arm and shoulder during and after repetitive and forceful movements.
• Weakness in the muscles of the palm (problem in carrying bags), grip and clumsiness of the fingers.

In untreated cases the condition may progress to wasting (atrophy) of the muscles of the hand under the thumb (thenar muscles).

Causes of Carpal Tunnel Syndrome

The median nerve travels from the forearm through the tunnel formed by the bones of the wrist joint to muscles of the palm. It provides sensation (sensory function) to the all the fingers except part of the ring finger and whole of the little finger and controls (motor function) muscles around the thumb (thenar muscles).

Although exact cause of most of the cases of carpal tunnel syndrome is not known, an interplay of different factors appears to lead to the problem. Any condition that leads to narrowing (crowding) of the (carpal) tunnel and irritation of the nerve can lead to carpal tunnel syndrome. It is believed that repetitive hand activities causes the tendons that also runs in this tunnel to swell and compress the median nerve. However, other factors may also play a role, particularly in seniors.

• Charcot Marie Tooth syndrome (type 1): hereditary disease characterized by compression of various nerves due to increased pressure (pressure palsy).
• Defect in the adjacent ganglia, blood vessels may lead to increased external pressure on the tunnel ( which in turn affects the median nerve).
• Increased pressure on the nerve due to presence of tumor (lipoma) may cause CTS.
• Rheumatoid arthritis can cause inflammatory changes in the wrist joint leading to irritation of the median nerve.
• Associated conditions: diabetes, hypothyroidism (fluid accumulation in the wrist joint), pregnancy and acromegaly.

Risk factors

Some of the risk factors for developing carpal tunnel syndrome includes :

• Nerve damaging conditions (neuropathy) including alcoholism or diabetes.
• Inflammatory conditions such as rheumatoid arthritis or scleroderma.
• Increased fluid accumulation in the wrist joint seen with pregnancy, menopause, obesity, hypothyroidism (myxedema), liver and kidney failure.
• Drug induced through the use of oral contraceptive pills.
• Associated with other medical conditions like acromegaly, obesity or infection with parvovirus.
• Fracture of the wrist bones.
• Working conditions where there is repetitive movements at the wrist joint and use of vibrating tools.

Treatment of Carpal Tunnel Syndrome

Mild to moderate symptoms of CTS are managed with :

• Resting of the joint by using specially designed splints.
• Anti-inflammatories, analgesics and steroids (oral and injection).
• Ice packs.
• Physical therapy.
• Occupational therapy.

Treatment of the underlying disease, if any is present, needs to be attended to. Persistent and severe symptoms are managed with either open or endoscopic surgery to relieve pressure on the nerve.