Types of Carpal Tunnel Syndrome

The Different Types/Stages of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome can range from a mild discomfort that can be reduced by resting the hand, up to a painful and disfiguring situation that can cause difficulty in performing tasks and can impact on quality of life.

It is not known exactly how the process leading to Carpal Tunnel Syndrome actually evolves but there are essentially three ways that it can manifest itself:

• The swelling of the tenosynovium (the protective lining of the tendons) within the carpal tunnel can occur as a result of a build up of the Synovial fluid that usually lubricates and protects the tendons.
• A thickening of the Transverse Ligament; a band of fibrous tissue that usually protects the median nerve can become thicker and broader, putting pressure on the nerve it is supposed to be protecting.
• The thickened ligament and swollen tendons can press on the median nerve fibres causing reduced blood flow and oxygen supply to the nerve which slows the transmission of nerve signals through the carpal tunnel. In some cases the syndrome can be as a result of the enlargement of the median nerve rather than compression by surrounding tissues.

In terms of measuring the severity of Carpal Tunnel Syndrome, there are a variety of methods in use; many of them relying on the patient’s own description of the pain and discomfort they are suffering.

One popular measurement tool is the questionnaire published by the Boston Group. This includes a range of questions going into detail about sensation, pain, loss of movement etc and is graded using measurements of SSS: Symptom Severity Scale, indicating how bad the symptoms feel to the patient and FSS: Functional Status Scale, indicating how much interference the symptoms cause in daily living. Each score can range from 1 – no symptoms to 5 – very severe symptoms.

In cases where the scores are very low, the condition can frequently be treated with rest, wrist support or sometimes anti-inflammatory drugs. When the scores are higher this can be as a result either of the condition having gone undetected for a long period of time and thus it has had the chance to develop significantly, or in some cases a more aggressive form of the condition. In these cases surgery might be the most suitable treatment, although it must be noted that not all surgery leads to a long-term reduction in the symptoms.