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From Early Signs to Chronic CTS: The Stages of Carpal Tunnel Syndrome

white female wrist painLiving with carpal tunnel syndrome (CPT) can make everyday tasks painful and difficult. Pain that increases at night can also impact sleep, affecting your mental health and well-being. For many people, carpal tunnel syndrome symptoms can be managed by paying attention to wrist posture, stretching, rest, and avoiding repetitive hand motions to prevent flare-ups. Though carpal tunnel is a chronic condition, there are a variety of conservative treatments, like splints or steroid injections and lifestyle modifications, that help relieve pain and improve quality of life. For patients with advanced or chronic CTS, these treatments may be inadequate, and surgical options, such as carpal tunnel release surgery, to provide long-term relief. 

Stage 1 - Early Warning Signs and Symptoms of CTS:

Although there are many conditions similar to carpal tunnel the most common early sign of CTS is tingling, numbness, or a burning sensation in the thumb, index, middle, or ring fingers. This discomfort typically starts gradually and is often felt at night or when waking up but goes away quickly with shaking or massage. 

Symptoms usually come and go at first, becoming more consistent over time. If you are experiencing the beginning stages of carpal tunnel, you might notice:

  • Aching pain in the wrist, hand or forearm
  • Feeling as if your hands/wrist are numb or weak
  • Tightness or swelling in fingers/wrist
  • Hands and fingers may feel swollen even if there is no visible swelling
  • Numbness of fingers spreading to palm
  • Difficulty making a fist or pinching fingers together

Stage 2 - Progression and Consistency of Symptoms:

As carpal tunnel syndrome progresses, symptoms become more frequent and longer-lasting. Numbness and tingling may extend from the hand to the wrist and forearm. Weakness and clumsiness may occur in the hand, making it difficult to perform some tasks of daily living. 

  • Frequent numbness, tingling, or burning in the fingers
  • More persistent pain and aching in the affected hand, wrist, or forearm
  • Noticeable hand weakness or difficulty gripping objects
  • Clumsiness and difficulty manipulating small objects or opening jars
  • Fingers feeling swollen with a tight wristband sensation
  • Nighttime symptoms waking patient up at night
  • Shock sensations down the arm with certain motions
  • Reduced grip strength making it hard to hold objects for long
  • Loss of coordination in the hand that may affect some daily tasks

Stage 3 - Chronic CTS and Long-term Effects:

During advanced or chronic stages of carpal tunnel syndrome, symptoms are constant and significant. There is persistent numbness, tingling, pain, and weakness in the hand and thumb, also affecting the lower arm. In addition to the symptoms above, severe carpal tunnel syndrome may cause muscle atrophy or loss of muscle density at the base of the thumb. The following symptoms are also indicators of chronic CTS.

  • Constant numbness, tingling, and pain in the fingers, hand, wrist, and forearm
  • Loss of sensation in the fingers and hand
  • Severe weakness in grasping objects and performing fine hand movements
  • Difficulty with activities of daily living such as buttoning clothes or opening jars
  • Loss of coordination and function in the affected hand
  • Persistent wrist pain that disturbs sleep nightly
  • Loss of dexterity and inability to feel objects in the hand
  • Clumsiness, causing objects to be frequently dropped
  • Spread of numbness and tingling into palm and back of hand
  • Wrist and hand pain that is unrelieved with shaking or massage

Diagnosis and Treatment Options for CTS:

To find out if you have CTS, our doctors will do a physical exam of your wrist and hand and may order a nerve test to determine the severity of your condition. Depending on how severe the symptoms are, treatments for carpal tunnel syndrome can include wearing a wrist splint, changing activities to avoid strain on your wrist, getting a steroid shot, or having surgery to take pressure off the nerve. 

Wrist Splinting

Wearing a wrist splint is typically one of the first treatments recommended for carpal tunnel syndrome. The rigid splint keeps the wrist in a neutral position, taking the pressure off the pinched median nerve. Splints are often recommended at night, but they may also be worn during the day for certain activities. This provides support, limits wrist flexing, and alleviates nerve compression. While this is not a cure, splints can provide significant symptom relief, especially for mild to moderate carpal tunnel syndrome.

Steroid Injections

Corticosteroid injections into the area of the wrist affected (the carpal tunnel) is another standard, minimally invasive CTS treatment option. The steroid injection reduces inflammation around the median nerve, decreasing pressure on the nerve. Patients can experience symptom relief for up to 6 months after the injection, often delaying the need for surgery. 

Carpal Tunnel Release Surgery 

For severe or chronic carpal tunnel syndrome, surgery may be recommended. The goal of carpal tunnel release surgery is to relieve pressure on the median nerve by cutting the transverse carpal ligament. This is a minimally invasive outpatient procedure providing nearly immediate pain relief for most patients. Recovery involves physical therapy to regain strength and range of motion. Though symptoms recur in a small percentage of patients, carpal tunnel surgery is highly effective at providing long-term relief when nonsurgical options are insufficient.

Preventing and Managing Carpal Tunnel Syndrome:

black female wrist painIf you perform repetitive tasks with your hand and wrist, such as typing, carpal tunnel syndrome symptoms can be prevented or managed by taking frequent breaks, maintaining proper wrist posture, and addressing risk factors. Stretching and hand exercises can keep muscles flexible and prevent nerve compression. If you start to have symptoms, rest, wrist splints and ergonomic equipment can help by reducing strain and pressure on the median nerve. 

If symptoms develop, conservative treatments like over-the-counter anti-inflammatories, hand therapy, and steroid injections may provide relief along with lifestyle modifications. 

World-Renowned Carpal Tunnel Syndrome Specialists in New Jersey

The Institute for Advanced Reconstruction offers one-to-one consultations at all our locations for all the different types of carpal tunnel syndrome. The best treatment approach for you will depend on your unique needs and health-related factors. With this in mind, our highly skilled reconstructive plastic surgeons will review your medical history, answer your questions, and provide personalized surgical recommendations to reach your ideal outcome.