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8054 Yonge St. Thornhill. Just south of the intersection of Yonge and HWY 7/407

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What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy condition that causes pain, numbness, and tingling in the fingers, hand, or wrist. It occurs when the median nerve becomes pressed or squeezed at the wrist.

It can also affect the muscles in the hand and fingers, resulting in weakness, difficulty moving your fingers, and muscle spasms. In most patients, carpal tunnel syndrome gets worse over time. If untreated for too long, it can lead to permanent dysfunction of the hand, including loss of sensation in the fingers and weakness (Paduaet al, 2016).

For this reason, it is critical to detect and treat carpal tunnel syndrome promptly.

If left untreated, the muscles of the hand may waste away or atrophy, more severe cramping will develop, and the median nerve will begin to deteriorate, causing loss of feeling, hand strength, and coordination around the thumb.  Permanent damage to the muscles and the hand will result.

Anatomy of the carpal tunnel

The carpal tunnel is a narrow tube formed by the carpal bones on the bottom of the wrist and the transverse carpal ligament across the top. The median nerve is the longest nerve in the human body and runs through the carpal tunnel in the forearm.

It is responsible for the sensory and motor functions of the thumb and three middle fingers. As a result, CTS can affect the sensation and control of the thumb and fingers of the affected hand.

The flexor tendons, responsible for bending the fingers and thumb, travel alongside the nerve through the carpal tunnel; these tendons connect your muscles to the bones in your hand and help you move your fingers.

How does CTS develop?

CTS develops over time as the median nerve is compressed by the tendon or ligament within the carpal tunnel. The simple act of bending a finger or wrist sets in motion an intricate system of muscles and tendons, each playing its crucial role. In fact, just one bend can cause a tendon to travel up to two inches.

The tendons of the hand are enclosed in sheaths, or sleeves, through which the tendons slide. The sheath’s inner wall has cells that generate a lubricant to facilitate proper and seamless tendon function; this is imperative for a tendon’s regular operation.

With the repetitive or excessive movement of the hand, the lubrication system may malfunction. It may not produce enough fluid or it may produce a fluid with poor lubricating qualities.

Failure of the lubricating system creates friction between the tendon and its sheath, causing inflammation and swelling of the tendon area. When the tendons become inflamed, they make the tunnel narrow and press down on the median nerve which is more delicate.

Over time the nerve becomes damaged by the constant pressure, resulting in numbness, tingling, pain, and weakness in the hand and fingers.

What are the symptoms of carpal tunnel syndrome?

The symptoms of CTS typically emerge in a slow and progressive manner without any associated trauma. The early symptoms include:

  • Numbness at night
  • Tingling and/or pain in the thumb, index, and middle fingers

As symptoms worsen, people might feel:

  • Pain or tingling that may travel up the forearm toward the shoulder
  • Weakness and clumsiness in the hand — this may make it difficult to perform fine movements such as buttoning clothes, handling small objects, grasping a steering wheel to drive, or using a computer keyboard
  • Dropping things — due to weakness, numbness, or a loss of manual dexterity

Nighttime symptoms are very common and are often the first symptoms reported. Since many people tend to sleep with their wrists curled, the pain awakens them from sleep. Many patients find that shaking their hands helps relieve symptoms in the early stage of the condition.

Daytime symptoms occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.

In chronic and/or untreated cases, the muscles at the base of the thumb may shrink and waste away (called atrophy). In fact, some people with very severe CTS cannot even differentiate between hot and cold by touch and may burn their fingertips without knowing it as a result.

How common is carpal tunnel syndrome (CTS)?

Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies (Yang, 2022).

What are the causes of carpal tunnel syndrome (CTS)?

According to the National Institute of Neurological Disorders and Stroke (USA), CTS often develops as a combination of factors resulting in increased pressure on the median nerve in the carpal tunnel.

The most common cause is repetitive hand and forearm use such as operating heavy equipment, plumbing, doing electrical work, typing, reaching, prolonged driving, playing piano, or using a computer keyboard for extended periods of time. Other causes include age, obesity, genetics, and certain medical conditions.

People who work in construction, manufacturing industry, clerical jobs, or use a computer keyboard for a prolonged period of time are more likely to experience carpal tunnel syndrome.

Risk factors associated with carpal tunnel syndrome (CTS)

Occupational risk factors for carpal tunnel syndrome:

  • Tasks involving repetitive hand motions (cashiers, hairdressers, or knitters/sewers)
  • Tasks involving strong gripping and awkward hand positions (kneading dough, milking cows, using a spray paint gun, hand-weeding)
  • Repeated use of vibrating hand tools, assembly line workers

Non-occupational risk factors for carpal tunnel syndrome:

  • Gender (women have three times more risk due to the comparatively small size of carpal tunnel)
  • Arthritis (an inflammatory condition)
  • Diabetes (a condition associated with nerve damage)
  • Amyloidosis (infiltration of the liver, kidneys, and spleen with a starch-like substance)
  • Hypothyroidism (underactive thyroid gland)
  • Tumors of tendon sheaths, wrist fractures, dislocations, wrist cysts (anatomic factors)
  • Pregnancy, Menopause (fluid retention)
  • Obesity
  • Use of oral contraceptives (medication)

These disorders and conditions increase the volume of the carpal tunnel contents, resulting in median nerve compression (Yang et al, 2022).

How is carpal tunnel syndrome diagnosed?

Carpal tunnel syndrome is typically diagnosed through a physical examination, medical history review, wrist ultrasound, and nerve conduction tests, which measure the speed of nerve signals passing through your hand and wrist.

Your doctor may also order imaging tests, such as an X-ray or MRI, to rule out other causes of your symptoms.

  • Physical examination: A physician will evaluate your hands, arms, shoulders, and neck to see if the symptoms are due to everyday activities or an underlying problem, and to rule out other disorders that may mimic carpal tunnel syndrome. Tenderness, swelling, warmth, and discoloration in your wrist will also be evaluated. Fingers will be tested for sensation and muscles for strength and signs of atrophy.
  • Routine laboratory tests and X-rays: These tests are used to rule out fractures, arthritis, and nerve-damaging diseases such as diabetes.
  • Tinel’s test: The physician taps on or presses the median nerve at the wrist. A tingling response in one or more fingers indicates damage to the median nerve.
  • Phalen’s test (wrist-flexion test): The patient is asked to bend the wrists for one minute while putting the backs of the hands together. Tingling or increasing numbness of the fingers indicates damage to the median nerve.
  • Wrist ultrasound: This measures the thickness of the median nerve, shows the anatomy of the carpal tunnel, and allows for evaluation of nerve compression at various stages of CTS.
  • Electrodiagnostic test: It measures the electrical activity in the muscle. During a nerve conduction study, electrodes that generate small electrical signals are placed on the forearm of the patient. In electromyography, a fine needle is inserted into the muscle. Assessments of how quickly and well the median nerve conveys information to muscles show whether or not the nerve has been damaged.

How is carpal tunnel syndrome treated?

Treatment for carpal tunnel syndrome depends on the severity of the symptoms. There are several treatment options for carpal tunnel syndrome, including both non-surgical and surgical approaches.

Non-surgical approaches include:

  • Wrist splinting/bracing
  • Cold packs
  • Physical therapy, activity modifications, and nerve gliding exercises
  • Medications – nonsteroidal anti-inflammatory drugs (NSAID) or corticosteroids to reduce inflammation.
  • Occupational therapy – improving the ergonomics of your workstation or modifying day-to-day activities to reduce stress on the carpal tunnel
  • Dietary changes to reduce weight and inflammation

Surgery is indicated only if the symptoms are severe or other treatment measures do not provide sufficient relief. The goal of surgery is to relieve pressure by cutting the ligament pressing on the median nerve.

The surgery may be an open surgical procedure or an endoscopic procedure and often can be done on an outpatient basis (Wang et al, 2018).

What do we offer at WMC?

At the Wilderman Medical Clinic, we offer a variety of interventional and non-interventional treatment options, including:

Interventional pain management for carpal tunnel syndrome:

  • Cortisone injections for carpal tunnel syndrome
  • Prolotherapy injections for carpal tunnel syndrome
  • Hydrodissection procedure for carpal tunnel syndrome
  • PRP (plasma-rich protein) injections for carpal tunnel syndrome

Non-interventional pain management for carpal tunnel syndrome:

  • Psychotherapy
  • Kinesiology education sessions
  • Exercises for carpal tunnel syndrome
  • Splinting for carpal tunnel syndrome

How can we prevent carpal tunnel syndrome?

Prevention of carpal tunnel syndrome involves taking frequent breaks to stretch and rest your hands during repetitive tasks, maintaining a neutral wrist position during activities such as typing or using a mouse and adjusting your workstation ergonomics to reduce the strain on your hands and wrists.

At night, keep your wrist straight while resting or asleep to prevent pressing on the nerve and carpal tunnel. Making lifestyle modifications to maintain a healthy weight and reduce inflammation also lowers the risk of developing conditions like CTS.


1. Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, Caliandro P, Hobson-Webb LD. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016 Nov;15(12):1273-1284. doi: 10.1016/S1474-4422(16)30231-9. Epub 2016 Oct 11. PMID:27751557.

2. Wang L. Guiding Treatment for Carpal Tunnel Syndrome. Phys Med RehabilClin N Am. 2018 Nov;29(4):751-760. doi: 10.1016/j.pmr.2018.06.009. Epub 2018 Sep 17. PMID: 30293628.

3. Yang C, Chen HH, Lee MC, Kao HK, Lin YT, Chen CT, Chang CJ, Tsai CH. Risk Factors of Carpal Tunnel Syndrome in Taiwan: A Population-Based Cohort Study. Ann Plast Surg. 2022 Jan 1;88(1):74-78. doi: 10.1097/SAP.0000000000002950. PMID: 34270471


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