Carpal Tunnel Syndrome Home A-Z Health Information Health Library A-Z Carpal Tunnel Syndrome Overview Carpal tunnel syndrome (CTS) is the compression of the median nerve in the carpal tunnel of the wrist joint. Symptoms Numbness and tingling sensations along the thumb, index, middle finger, and outer half of the ring finger, affecting sleep, especially at night.Pain radiating up to the forearm or shoulders.In advanced stages, weakness and atrophy (shrinkage) of hand muscles lead to loss of grip and dropping objects. Risk factors Women are more prone to develop CTS than men.Hereditary factors.Old fractures of the wrist.Frequent and repetitive wrist movements, such as typing.Associated with medical conditions, such as diabetes, obesity, hypothyroidism, pregnancy, and rheumatoid arthritis. Diagnosis Gentle tapping along the course of the nerve causes a current-like/tingling sensation (Tinel’s sign).Holding the bent wrist to elicit the pain/tingling/numbness sensation associated with nerve compression.Assessing muscle power and atrophy in the handAlthough CTS diagnosis is usually clinical, the following examinations may be required for confirmation:Radiography (X-ray) to rule out old fractures in the wrist.Ultrasonography to assess the carpal tunnel anatomy and understand the probable cause of nerve compression.Electromyography (EMG) to assess hand muscle activity.Nerve conduction velocity (NCV) to measure the electrical signals along the nerves of the hand and wrist. EMG and NCV are usually performed simultaneously.Magnetic resonance imaging (MRI) is rarely required to identify rare causes of compression. Treatment Non-surgical treatmentErgonomics and splinting for patients with occupation-related causes during the early course of the diseaseMedications, such as anti-inflammatory drugs, oral or intravenous steroids, vitamin B6, and glucocorticoids or diureticsSurgical treatmentSurgical treatment is required for patients who are at an advanced stage of the syndrome and in whom conservative management fails. The surgical treatment approaches for CTS are:Conventional open carpal tunnel release through arthroscopy procedures.Endoscopic approach.