Carpal Tunnel Syndrome – Your Guide to Prevention and Treatment
Carpal tunnel syndrome (CTS) is a condition characterized by numbness, weakness and tingling of the hand and fingers caused by pressure on the median nerve at the wrist. Usually, only one hand is affected but it is possible to have the condition in both hands at the same time.
An astounding four to ten million Americans suffer from carpal tunnel syndrome. Two percent of men and three percent of women will be diagnosed with the nerve disorder sometime during their lifetime, making it the most common nerve disorder experienced today. Women are more likely to develop the condition than men and carpal tunnel syndrome is also more common in people who have a family history of the disorder.
Before we further discuss the symptoms of CTS, understanding a little bit about the anatomy of the wrist and hand can be very useful. The median nerve is one of the three major nerves of the arm and hand and provides both motor (movement) and sensory (feeling) functions for the hand. Some of the motor and sensory functions for the hand are supplied by the ulnar nerve as well, but the median nerve is the only nerve that passes through what is known as the carpal tunnel.
The carpal tunnel is a narrow space in your wrist formed by some of the wrist bones together with the transverse carpal ligament. These structures are not very flexible, so if there is any swelling due to inflammation this can put pressure on the blood vessels in the area as well as the median nerve. This pressure can cause a restriction in blood flow and lead to damage of the nerve, accounting for the symptoms.
Carpal tunnel syndrome is a progressive disorder, with symptoms becoming more pronounced with time. Early in the course of CTS, patients report pain in the wrist and in the palm side of their hand as well as numbness, tingling and even burning of the middle, index and ring fingers on the palm side of the fingers. Sometimes these symptoms are reported to radiate to the forearm or shoulder.
Later, as CTS progresses, patients report numbness in their hand and fingers and may also experience weakness. Some people have trouble holding on to objects and may lose the ability to feel hot and cold. Strangely enough, many people with severe CTS report that the affected hand feels swollen, even when there are no visible signs of swelling. Plus, people who suffer from CTS often have symptoms at night, even when they are not using their hands. In fact, night symptoms can help to distinguish CTS from other conditions which cause some of the same symptoms.
The symptoms of CTS are brought about by an inflammation of the median nerve. This inflammation can be caused by what is known as repetitive stress (such as the constant use of the hands in a repetitive occupation), a physical injury or a medical condition such as osteoarthritis, rheumatoid arthritis, obesity, pregnancy, diabetes and hypothyroidism.
Almost fifty percent of cases of CTS are associated with a workplace cause, but there is really no clear cut cause and effect relationship. The current research suggests that when someone who is prone to developing CTS is exposed to repetitive work involving the wrist or hand, CTS is likely to develop.
There are specific types of jobs that put people at risk for developing CTS, especially if they have an underlying condition or family history that makes them prone to developing the syndrome. These types of jobs include: truck drivers, carpenters, painters, cooks, welders, automotive service technicians, nursing aides, orderlies and other medical attendants, computer users and typists, meat and fish packers, cashiers, hair stylists and musicians among others.
First of all, your medical provider should take a thorough history, asking about underlying disorders such as diabetes and hypothyroidism as well as inquiring about a family history of CTS. The provider will also want to know about your job and will ask about any activities of a repetitive nature and also inquire about a history of a physical injury to your wrist or hand.
Your medical provider will conduct a physical exam, which will include checking the sensation as well as the physical strength of your hands, wrists, arms, shoulders and neck. Your doctor may also tap the inside of your wrist with a reflex hammer to see if symptoms are replicated. Once this is completed, your medical provider may order a nerve conduction study (EMG-NCV) to test the function of the nerve as it passes through the carpal tunnel. Blood tests may be ordered to rule out an undiagnosed underlying disorder such as hypothyroidism or diabetes.
Fortunately, early on in the disorder, CTS is reversible. But left untreated, permanent nerve damage can occur, including a wearing away of the nerve’s protective insulating cover, leaving the person with permanent pain, muscle weakness and nerve symptoms. If pregnancy is the cause of a woman’s CTS, symptoms almost always disappear with delivery.
If CTS is diagnosed early, a conservative approach is best. This approach can include splinting, limiting activity and ultrasound treatments. Splints are typically worn at night and when engaging in sports and are usually used for several weeks and sometimes months. Non-steroidal anti-inflammatory drugs (NSAIDS) such as naproxen or ibuprofen, can help with pain and discomfort but do not correct the underlying problem. If your CTS is caused by repetitive motion, doing less of the offending activity is recommended as well as more frequent breaks.
There are certain hand and finger stretching and strengthening exercises that could help as well, but always check with your medical provider before implementing these or any other ‘do it yourself’ remedy. Some studies suggest that yoga practice can help to relieve symptoms of CTS.
If these conservative measures are not effective, corticosteroid injections into the area of the carpal tunnel may be tried. These drugs work to reduce the swelling in the area and relieve pressure on the nerve. Most CTS patients get good results from these injections but in about fifty percent of patients, symptoms return within a year. Research shows that injecting a second time does not confer additional benefit.
There are a number of alternative treatments which have been recommended for CTS, including the use of Vitamin B6, acupuncture, chiropractic adjustment, magnets and even include the use of injections of Botulinum Type A. None of these alternative therapies have proven to be effective.
If conservative measures fail, then carpal tunnel release surgery is indicated, and is one of the most commonly performed surgeries in the United States. About seventy to ninety percent of patients who choose to have surgery had relief of their nighttime pain after the procedure. Research shows that surgery, over the long term, is a more effective treatment than splinting or anti-inflammatory drugs with the addition of physical therapy.
But surgery is not effective for all patients. Generally, surgery has a better chance of being successful if you are in good overall health, you have the surgery within three years of being diagnosed with CTS, you have CTS diagnosed by nerve conduction studies but the muscle mass in your hands is still relatively good and your symptoms are worse at night versus during the day.
You have a reduced chance of a good outcome from surgery if your symptoms are very severe prior to surgery, you are over fifty years of age, your CTS symptoms have been present for more than ten months, you do heavy manual labor for a living, you are on hemodialysis, you abuse alcohol, or you suffer from diabetes or hypertension.
Surgery is straightforward and involves making an incision in the wrist and simply cutting the transverse carpal ligament, relieving pressure on the nerve. The surgery can also be done by making a smaller incision and using an endoscope to view the area and then perform the surgery. Patients who elect the endoscopic procedure generally have less pain and can return to normal activity in about half the time but the long term outcome for both types of surgeries is the same.
Ideally, measures can be taken to prevent the onset and development of CTS. But as you can see, due to the many and varied factors which contribute to the disease, it’s not easy to come up with a standard set of preventative suggestions.
Of course, if a person with CTS has an underlying medical disorder, such as diabetes or hypothyroidism, it’s important to get that treated.
CTS caused by work related, repetitive stress on the wrists is perhaps most amenable to prevention. Proper adjustment of one’s work area, including optimal angle of computer keyboards, desk height and seating are critical. Instruction in proper posture as well as exercises which work to strengthen the fingers, hands and wrists as well as the arms, shoulders and neck can go a long way in terms of preventing problems. Frequent short breaks, warming up before beginning work as well as varying your tasks can also be very helpful.
If you suspect you may have carpal tunnel syndrome, seeing a qualified medical provider at your earliest convenience is recommended.
CTS can be very successfully treated if caught early, but if you wait until your symptoms have become severe, you risk permanent nerve damage and disability.
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