Carpal tunnel syndrome (CTS) is a condition that touches the lives of many, manifesting as a spectrum of symptoms that can evolve from mild inconvenience to debilitating impairment. Understanding the stages of CTS is crucial for timely intervention and effective management of this common neurological disorder. As we explore the journey from the initial signs to the potential for lasting nerve damage, we also shed light on an innovative approach — carpal tunnel release using UltraGuideCTR™ and real-time ultrasound guidance (CTR-US). This minimally invasive approach may provide relief from carpal tunnel symptoms without the need of traditional invasive surgery.1-4
Join us on this journey as we explore the stages of CTS and highlight how CTR-US using UltraGuideCTR is providing individuals with an alternative treatment option for carpal tunnel relief.
What Is Carpal Tunnel Syndrome (CTS)?
Carpal tunnel syndrome is a condition that occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers, except the little finger, as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel—a narrow, rigid passageway of ligament and bones at the base of the hand—houses the median nerve and tendons. When this tunnel becomes narrowed or when tissues surrounding the flexor tendons swell, it can lead to nerve compression, causing the characteristic symptoms of CTS.
Common causes & risk factors that can contribute to the development of CTS are repetitive hand movements, improper wrist position, hereditary, pregnancy, health conditions such as diabetes, rheumatoid arthritis and thyroid gland imbalance, age, obesity, gender and the presence of other health conditions that may affect the nerves. With the prevalence of technology use and certain occupations, it’s no surprise CTS is the most common peripheral nerve entrapment in the world, making it a common yet often debilitating condition. Recognizing the impact of CTS on individuals’ quality of life, it is crucial to understand its progression and the available treatment options.
Early Signs and Symptoms of CTS
Carpal tunnel syndrome typically begins with subtle, often overlooked symptoms that can gradually disrupt daily life. Numbness and tingling sensations frequently emerge in the fingers, particularly the thumb, index, and middle fingers, which are hallmark early signs of CTS. These sensations might initially come and go, becoming more noticeable during nighttime or after certain activities that involve wrist flexion, like driving or reading. Most of the time, the pain will cease after shaking the hand. In the early stages of CTS there is generally no noticeable swelling.
Recognizing these early symptoms is crucial for timely intervention. Occasional discomfort in the wrist and hand might accompany the numbness, prompting individuals to shake out their hands for relief. Awareness of such discomfort is important, as early diagnosis and treatment can help prevent symptom progression and reduce the likelihood of long-term damage to the median nerve.
Progression to Moderate Stage CTS
As carpal tunnel syndrome advances into the moderate stage, patients could experience an intensification of symptoms. The once sporadic numbness and tingling in the fingers can become more persistent, and discomfort may extend to the entire hand and wrist. Aching sensations and discomfort in the forearm may also accompany these symptoms. Symptoms start to appear during the day and become more evident when individuals participate in activities that repetitively involve the hand or wrist. Some patients might experience reduced hand strength, often resulting from persisting numbness or muscle weakness due to median nerve compression.
The impact of moderate stage CTS on daily life can be significant, making tasks that involve fine motor skills, such as typing, buttoning clothing, or gripping objects, increasingly challenging. Some individuals may notice that their hands feel clumsy or that they’re dropping things more often. At this point, the hand muscles may start to exhibit signs of weakness, which can be particularly troublesome for those whose occupations require strong, precise hand movements.
Advanced Stage CTS and Its Complications
As carpal tunnel syndrome progresses to its advanced stages, the symptoms typically become more severe and constant. Individuals may experience persistent numbness and a noticeable decrease in grip strength. The tactile sensation in the fingers may diminish, leading to difficulties in distinguishing between hot and cold or in performing tasks that require fine motor skills.
The physical manifestations of advanced CTS also include muscle wasting, particularly at the base of the thumb, which is known as thenar atrophy or hypertrophy. This deterioration of muscle tissue can be visually apparent and is a sign of prolonged nerve compression. In the absence of timely and effective treatment, patients face the risk of permanent nerve damage, which can result in irreversible loss of hand function and sensation. This stage of CTS underscores the critical need for individuals to seek medical attention upon noticing early symptoms to prevent the condition from reaching a debilitating level.
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Diagnostic Approaches for CTS
Carpal tunnel syndrome diagnosis begins with a thorough physical examination and detailed history taking to assess symptoms and identify potential risk factors. Physicians typically inquire about the nature of the patient’s pain, numbness, or weakness and how these symptoms affect daily activities.
They may also perform specific physical tests, such as the Tinel’s sign or Phalen’s maneuver, to provoke CTS symptoms and confirm the diagnosis.
Advanced diagnostic techniques include electrodiagnostic tests like nerve conduction studies and electromyography, which measure the electrical activity of muscles and the speed of nerve signals. These tests have been used to evaluate the severity of nerve compression and determine the best course of treatment.
Additionally, ultrasound imaging has emerged as a valuable tool, not only for painless, real-time diagnosis but also for guiding treatments like the CTR-US technique.5-6 Ultrasound allows for detailed visualization of the median nerve’s condition, enhancing precision in both diagnosis and intervention.
Traditional Treatments for CTS
Traditional treatments for Carpal tunnel syndrome (CTS) start with non-surgical options aimed at relieving symptoms and reducing pressure on the median nerve. Splinting the wrist, especially at night, helps to keep it in a neutral position, thereby lessening discomfort and allowing for rest periods for the affected nerve.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to alleviate pain and inflammation, while corticosteroid injections can provide temporary relief from symptoms by reducing swelling around the nerve.
When non-surgical methods fail to provide sufficient relief, or the condition progresses to a severe stage, surgical intervention may become necessary. Common surgical techniques include traditional open carpal tunnel release, which involves a larger incision in the palm, and endoscopic carpal tunnel release, which uses smaller incisions and a camera to guide the surgery. These surgical techniques aim to cut the transverse carpal ligament to relieve pressure on the median nerve and alleviate symptoms.
However, both come with risks of scarring, infection, and potentially long recovery times, which can impact a patient’s decision on whether to proceed with such treatment.7
An Innovative Technique – CTR-US with UltraGuideCTR
CTR-US is an innovative, minimally invasive treatment option for treating carpal tunnel syndrome. It is a procedure that involves creating a small incision in the wrist and guiding a low-profile device to transect the transverse carpal ligament. The wrist incision is typically closed with a sterile wound closure bandage rather than sutures.
While individual results may vary, one of the advantages of the CTR-US technique is the significantly reduced recovery time it offers when compared to traditional CTR techniques. Patients can typically resume their normal activities much sooner, often within days, which is a substantial improvement over the weeks of recuperation usually required after traditional surgery.1-4,7
CTR-US is typically performed under local anesthesia in an office-based environment, contributing to its less invasive nature. With generally low complication rates, fast recovery times, and minimal side effects, this minimally invasive treatment option for carpal tunnel syndrome offers several potential benefits.1-4,8-10
To determine if your symptoms could be related to carpal tunnel syndrome, consult with your doctor and consider scheduling a free screening.
Schedule a Free Carpal Tunnel Screening
As you begin to understand the stages of carpal tunnel syndrome, considering a timely diagnosis and treatment approach can alter the course of this condition. The impact of CTS is not to be underestimated, affecting not only the physical well-being of individuals but also their quality of life and ability to perform daily tasks.
With CTR-US using UltraGuideCTR, patients and healthcare providers now have access to a minimally invasive treatment option so patients can get back to normal activities quickly.1-4 To learn more about this technique visit our FAQ Page and consult with your healthcare provider to determine if CTR-US is appropriate for you.
Don’t let the discomfort and limitations of carpal tunnel syndrome hold you back. Schedule a Free Screening to determine if your symptoms could be related to CTS.
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Reference List
- Fowler JR, Chung KC, Miller LE. Multicenter pragmatic study of carpal tunnel release with ultrasound guidance. Expert Rev Med Devices. 2022;19(3):273-280. doi: 10.1080/17434440.2022.2048816.
- Eberlin KR, Amis BP, et al. Multicenter randomized trial of carpal tunnel release with ultrasound guidance versus mini-open technique. Expert Rev Med Devices. 2023;20(7):597-605. doi: 10/1080/17434440.2023.2218548
- Pistorio AL, Marwin VM, Paterson PD, Alexander RD, Nelson JT, Miller LM. Office-Based Carpal Tunnel Release with Ultrasound Guidance: 6-month Outcomes from the Multicenter ROBUST Trial. J Hand Surg Glob Online. 2024. https://doi.org/10.1016/j.jhsg.2023.12.005
- Cano L, Leiby BM, Shum LC, Ward MG, Joseph AE. Clinical results of carpal tunnel release using ultrasound guidance in over 100 patients at two to six years. J Hand Surg Glob Online. 2024. doi: https://doi.org/10.1016/j.jhsg.2024.02.004
- Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clinical Orthopaedics and Related Research. 2011;469:1089-1094. doi: https://doi.org/10.1007/s11999-010-1637-5
- Fowler JR, Munsch M, Tosti R, Hagberg WC, Imbriglia JE. Comparison of ultrasound and diagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard. The Journal of Bone & Joint Surgery. 2014;96(17):p e148. doi: 10.2106/JBJS.M.01250
- Miller LE, Chung KC. Determinants of return to activity and work after carpal tunnel release: a systematic review and meta-analysis. Expert Rev Med Devices. 2023;20:417–425. doi: https://doi.org/10.1080/17434440.2023.2195549
- Bergum RA, Ciota MR. Office-Based Carpal Tunnel Release Using Ultrasound Guidance in a Community Setting: Long-Term Results. Cureus. 2022;14(7): e27169. doi: 10.7759/cureus.27169
- Aguila D, Kirsch MJ, Kindle B, Paterson PD. Long-Term Clinical Results of Carpal Tunnel Release Using Ultrasound Guidance: A Multicenter Pragmatic Study. J Hand Surg Glob Online. 2023;6(1):79-84. https://doi.org/10.1016/j.jhsg.2023.10.001
- Paterson PD, Kirsch MJ, Miller LE, Aguila DJ. Early return to work after carpal tunnel release with ultrasound guidance. Plast Reconstr Surg Glob Open. 2024;12(2):p e5647. doi: 10.1097/GOX.0000000000005647
