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Carpal Tunnel Syndrome (CTS)

Symptoms, Diagnosis, & Treatment
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The orthopedic doctors and staff at Hand to Shoulder Center of Wisconsin understand carpal tunnel syndrome and how important the right carpal tunnel treatment is. Learn more about this syndrome and how the orthopedic team of specialists at Hand to Shoulder Center of Wisconsin can help you.

What is Carpal Tunnel Syndrome

Carpal tunnel syndrome (sometimes referred to as CTS) is a progressive, irritating, and in some cases, painful hand and arm condition. It is brought on by increased pressure on the median nerve that occurs at the level of the wrist. The median nerve is a pencil-size cord that contains thousands of nerve fibers running from your forearm through the carpal tunnel passageway in your wrist to your hand. It supplies feelings (sensations) to the palm side of your thumb and fingers, excluding the little finger. The median nerve, eight carpal (wrist) bones, and nine flexor tendons run through the carpal tunnel passageway at the wrist. When the carpal tunnel passageway becomes compressed, constricted, or irritated, the compression of the median nerve can lead to carpal tunnel syndrome – restricting the blood flow and the normal physiology to the nerve causing sensation such as “pins and needles” (numbness and tingling) or burning sensations in one or more of the fingers.

Studies confirm symptoms increase during sleep hours when the wrist is placed in a bent position (McCabe, 2007). In more advanced cases, numbness can be constant, or sharp piercing pain can occur in the wrist and radiate into the hand. Muscle weakness may occur, especially in the thumb. At times, the pain can extend into your forearm and shoulder area when forceful or repetitive use is demonstrated.

Carpal Tunnel Surgery & Non-Surgical Treatment Options

Pre-fabricated brace

Figure 1: Pre-fabricated brace

At Hand to Shoulder Center of Wisconsin, a thorough medical examination is conducted by a hand and upper extremity fellowship-trained orthopedic physician. Upon evaluation the physician will explore prior injuries, genetic medical conditions, and how the hands have been used. X-rays can be ordered to determine if arthritis is a factor or to detect any fracture conditions. Electrodiagnostic studies such as an electromyogram (EMG) or nerve conduction velocities (NCV) may be ordered.

  • EMG testing determines if there is muscle damage or loss in the thumb region
  • NCV testing measures the impulse of shock as it passes through the carpal tunnel passageway
Gliding and stretch exercise

Figure 2: Gliding and stretch exercise

In non-surgical carpal tunnel syndrome cases, mild symptoms may be gently subsided with rest and/or modification of daily activities. A wrist brace or splint can be applied to keep the wrist in a straight position to alleviate pressure on the median nerve (Fig. 1). Studies have shown that wearing a wrist brace during sleep hours only may be as effective as wearing a brace on a consistent basis (Huisstede, 2010). Intrinsic muscle stretching may aid in alleviating the symptoms (Fig. 2), (Baker, 2012). Occasional ice application may also be suggested. A steroid injection is another non-surgical treatment option which can help reduce the swelling that may be causing the median nerve compression. If conservative treatment fails, a surgical procedure may be recommended.

When carpal tunnel surgery is necessary, most are performed as an outpatient procedure. The carpal tunnel surgery procedure is referred to as “carpal tunnel release.” An incision is made on the palm side of the hand and the ligament that forms the top portion of the carpal tunnel passageway is released (cut). Pressure on the median nerve is relieved and blood flow is restored. Following the carpal tunnel surgery, patients can expect soreness or discomfort at the incision site for several weeks and up to several months for severe cases. Tendon glide hand exercises may be recommended to increase mobility (Fig. 3a-d).

Tendon glide hand exercise

Figure 3a: Tendon glide
hand exercise

Figure 3b: Tendon glide
hand exercise

Figure 3c: Tendon glide
hand exercise

Figure 3d: Tendon glide
hand exercise

In surgical cases performed by the orthopedic surgeons at Hand to Shoulder Center of Wisconsin, insurance benefits are verified by the Central Scheduling Department to determine the best insurance benefit options. All  surgeons perform surgery at Woodland Surgery Center, adjacent to Hand to Shoulder Center of Wisconsin, in Appleton, and have surgical privileges at the three local Fox Valley, WI hospitals. Surgical location is determined by the patient.


  • Baker NA, Moehling KK, Rubinstein ENI, et al. The comparative effectiveness of combined lumbrical muscle splints and stretches on symptoms and function in carpal tunnel syndrome. Arch Phys Med Rehabil. 2012; 93:1-10
  • Huisstede BM, Hoogvliet P, Randsdorp MS, et al. Carpal tunnel syndrome. Part I: Effectiveness of nonsurgical treatments-a systematic review. Arch Phys Med Rehabil. 2010; 291: 98-1004.
  • McCabe SJ, Uebele AL, Pihur V, Rosales RS, Atroshi I. Epidemiologic associations of carpal tunnel syndrome and sleep position: is there a case for causation? Hand (NY) 2007;2(3):127–34.
  • Katz JN, Larson MG, Sabra A, Krarup C, Stirrat CR, Sethi R, et al. The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings. Ann Intern Med 1990;112:321–7.

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