Overview
Carpal Tunnel Syndrome is the most common peripheral nerve entrapment neuropathy, caused
by compression of the median nerve as it passes through the carpal tunnel at the wrist.
It affects up to 10% of the population, with a higher prevalence in women, diabetics,
and those who perform repetitive wrist flexion-extension tasks. Symptoms range from
intermittent nocturnal tingling to persistent numbness and thenar weakness. Early
intervention prevents permanent nerve damage.
Symptoms & Causes
Common Symptoms
- Tingling and numbness in thumb, index, middle, and radial half of ring
finger
- Night pain waking the patient — classic hallmark
- Symptoms relieved by shaking the hand (the 'flick sign')
- Weakness in grip and thumb pinch (advanced cases)
- Thenar muscle wasting (severe / chronic CTS)
- Positive Phalen's test (wrist flexion for 60 seconds reproduces symptoms)
- Tinel's sign positive over the carpal tunnel
Common Causes
- Repetitive wrist flexion-extension work — keyboard use, assembly
- Diabetes mellitus (neuropathy lowers threshold)
- Pregnancy (fluid retention causes tunnel swelling)
- Hypothyroidism and acromegaly
- Rheumatoid arthritis — synovial proliferation
- Wrist fractures causing anatomical narrowing
- Obesity and sedentary lifestyle
Conservative & First-Line Treatment
- Neutral-position wrist splinting especially at night
- Activity modification and ergonomic keyboard/mouse setup
- NSAIDs and B-complex vitamins (B6, B12)
- Stretching exercises for median nerve and wrist flexors
- Control of underlying conditions (diabetes, hypothyroidism)
How Vedant Pain Management Clinic Can Help
Our interventional pain specialists offer the following evidence-based procedures, all
performed with real-time ultrasound guidance for precision and safety:
- Ultrasound-guided corticosteroid injection into the carpal tunnel — effective for
mild-to-moderate CTS, especially in pregnancy
- Ultrasound-guided median nerve hydrodissection — separating the nerve from
surrounding fibrotic tissue using fluid, restoring nerve glide
- Nerve Conduction Study (NCS) correlation to grade severity
- Diagnostic high-resolution ultrasound to measure median nerve cross-sectional area
(> 10 mm² confirms CTS) and identify causes such as tenosynovitis or ganglion
- PRP perineural injection for subacute nerve compression
- Guidance on when surgical decompression is warranted vs interventional treatment
Newer Diagnostic Concepts & Advances
Ultrasound-guided median nerve hydrodissection — injecting fluid around the median nerve
to restore nerve mobility and reduce fibrotic adhesions — has emerged as a highly
effective minimally invasive alternative to surgery for mild-moderate CTS. Multiple RCTs
now support its use, and Vedant Pain Clinic offers this advanced technique.
