The median nerve starts at the axilla and extends all the way down to the hand entering at the wrist through an area called the carpal tunnel. In CTS the nerve is pinched at that level (wrist). Causes of nerve impingement can be from repetitive use of the wrist (typing), pregnancy, thyroid problems, diabetes, and other disorders.
The typical presentation for CTS is numbness and tingling sensation in the first, second, third and half of the fourth digit, pain at the wrist that shoots up and down the arm. Symptoms are worse at nighttime, often waking up the patient from sleep, requiring the patient to shake off the hands to relieve the symptoms. Weakness in handgrip develops in moderate to sever cases.
The diagnosis of CTS is based on the clinical symptoms and physical examination. However, confirmation is done with nerve conduction velocities test and electromyography, which localizes the nerve impingement, and severity of it.
The treatment of the CTS depends on the severity of the nerve impingement. Mild CTS can be easily treated with the wrist splint or nerve block. Splits should be worn at all times and for several months. In moderate to severe cases surgery to release the nerve might be required to avoid progressive weakness and loss of function.