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In the Know - All about Carpal Tunnel Syndrome

In the Know

All about… carpal tunnel syndrome

 

No, carpal tunnel is not part of driving directions around the metro New York area—the “tunnel” in carpal tunnel has nothing to do with getting in and out of Manhattan (and “carpal” has nothing to do with cars, either).

 

But, like sitting in traffic in (or before entering) the Holland Tunnel, carpal tunnel can be painful.

 

Here’s what you need to know about this often-debilitating condition—and how to treat or even prevent it from striking in the first place.

 

 

Definition

Carpal tunnel syndrome is a medical condition that causes numbness, tingling and other symptoms in the hand and arm.

 

Carpal tunnel syndrome is most common among people whose white-collar jobs primarily involve repetitive and excessive usage of the fingers and wrists—writers, secretaries and others who type a lot every day.

 

The syndrome is also common among blue-collar workers who excessively use their hands for gripping and pushing. For example, carpal tunnel syndrome was once known as “meatpackers’ wrist” because New York City meatpackers would frequently get it due to their jobs. As such, carpal tunnel syndrome is also common among cabbies, bus drivers and truckers who grip steering wheels all day.

 

 

Symptoms

Carpal tunnel syndrome symptoms usually start gradually. The first symptoms often include numbness or tingling in your thumb, index and middle fingers that comes and goes. The condition may also cause discomfort in the wrist and the palm of the hand. Common carpal tunnel syndrome symptoms include:

 

Tingling or numbness

You may experience tingling and numbness in your fingers or hand. Usually the thumb and index, middle or ring fingers are affected, but not your little finger. Sometimes there is a sensation like an electric shock in these fingers.

 

The sensation may travel from your wrist up your arm. These symptoms often occur while holding a steering wheel, phone or newspaper. The sensation may wake you from sleep.

 

Weakness

You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.

 

 

Causes

Carpal tunnel syndrome is caused by pressure on the median nerve. This nerve runs from the neck and shoulder down through the arm—and into the hand through a tiny “tunnel” formed by a space between the bones of the wrist that is called the carpal tunnel.

 

The median nerve provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb.

 

The wrist also contains a ligament called the transverse carpal ligament. When this ligament gets overused by constant typing, gripping, pushing or holding, it becomes swollen and inflamed. (This is also known as repetitive strain injury (RSI).) The swollen and inflamed ligament then presses on the median nerve, resulting in carpal tunnel syndrome.

 

The anatomy of your wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome.

 

Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis.

 

Bottom line: in many cases of carpal tunnel syndrome, there is no single cause. Rather, a combination of risk factors contributes to its development.

 

Risk factors

A number of factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase chances of developing or aggravating median nerve damage. These include:

 

Computers and other workplace factors. Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome— as well as working with vibrating tools, on an assembly line, or any other work requiring prolonged or repetitive flexing of the wrist. According to the Mayo Clinic, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain. Many other experts disagree.

 

Anatomic factors. A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.

 

People with smaller carpal tunnels may be more likely to have carpal tunnel syndrome. This may be why carpal tunnel syndrome is generally more common in women: because a woman’s carpal tunnel is relatively smaller than a man’s.

 

Nerve-damaging conditions. Chronic illnesses like diabetes increase risk of nerve damage, including damage to the median nerve.

 

Inflammatory conditions. Illnesses defined by inflammation, like rheumatoid arthritis, can affect the lining around the tendons in the wrist and put pressure on your median nerve.

 

Alterations in body fluid balance. Fluid retention may increase pressure inside the carpal tunnel, irritating the median nerve. This is common during expectancy; carpal tunnel syndrome associated with expectancy generally resolves on its own.

 

 

Diagnosis

If you have persistent signs and symptoms that suggest carpal tunnel syndrome, see your doctor—especially they begin interfering with normal work/life activities and sleep patterns. Permanent nerve and muscle damage can occur without treatment.

 

To diagnose carpal tunnel syndrome, your doctor may ask questions and/or conduct any of the following tests:

 

History of symptoms. Your doctor will review the pattern of your symptoms. For example, because the median nerve doesn’t provide sensation to your little finger, symptoms in that finger may indicate a problem other than carpal tunnel syndrome. Carpal tunnel syndrome symptoms usually occur include while holding a phone or a newspaper, gripping a steering wheel, or waking up during the night.

 

Physical examination. Your doctor will conduct a physical examination. He or she will test the feeling in your fingers and the strength of the muscles in your hand. Bending the wrist, tapping on the nerve or simply pressing on the nerve can trigger symptoms in many people.

 

Other tests and procedures doctors may use to better isolate and diagnose carpal tunnel syndrome include x-rays, electromyograms and nerve conduction studies.

 

 

Treatment

Proper treatment usually relieves the tingling and numbness and restores wrist and hand function.

Treat carpal tunnel syndrome as early as possible after symptoms start.

 

Take more frequent breaks to rest your hands. Avoiding activities that worsen symptoms and applying cold packs to reduce swelling also may help.

 

Non-surgical treatments include wrist splinting and medications. These are most likely to help if you’ve had only mild to moderate symptoms for less than ten months.

 

Wrist splinting

This involves a splint that holds your wrist still while you work and especially while you sleep, helping relieve symptoms of tingling and numbness.

 

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term. There isn’t evidence, however, that these drugs improve carpal tunnel syndrome.

 

Corticosteroids

Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve pain. The doctor may sometimes use an ultrasound to guide these injections.

 

Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren’t considered as effective as corticosteroid injections for treating carpal tunnel syndrome.

 

Surgery

Surgery may be appropriate if symptoms are severe or don’t respond to other treatments. The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve. The surgery may be performed with two different techniques:

 

Endoscopic surgery. The surgeon uses an endoscope, a telescope-like device with a tiny camera attached to it, to see inside the carpal tunnel. The surgeon will then cut the ligament through one or two small incisions in the hand or wrist. Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.

 

Open surgery. The surgeon makes an incision in the palm of the hand over the carpal tunnel and cuts through the ligament to free the nerve.

 

Alternative medicine

Integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your doctor before trying any complementary or alternative treatment.

 

Yoga. Yoga postures designed for strengthening, stretching and balancing the upper body and joints may help reduce pain and improve grip strength.

 

Hand therapy. Early research suggests that certain physical and occupational hand therapy techniques may reduce symptoms of carpal tunnel syndrome.

 

Ultrasound therapy. High-intensity ultrasound can be used to raise the temperature of a targeted area of body tissue to reduce pain and promote healing. Research shows inconsistent results with this therapy, but a course of ultrasound therapy over several weeks may help reduce symptoms.

 

 

Prevention and prognosis

There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on your hands and wrists with these methods:

 

  • Take short breaks from repetitive activities involving the use of your hands

  • Lose weight if you are overweight or obese

  • Rotate your wrists and stretch your palms and fingers

  • Take a pain reliever, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve)

  • Wear a snug, not tight, wrist splint at night. You can find these over-the-counter at most drugstores or pharmacies

  • Avoid sleeping on your hands

  • Reduce your force and relax your grip. Hit cash register or keyboard keys softly. Use a big pen with an oversized, soft grip adapter and free-flowing ink.

  • Take frequent breaks. Gently stretch and bend hands and wrists periodically. Alternate tasks when possible.

  • Avoid bending your wrist all the way up or down; a relaxed middle position is best.

  • Keep your keyboard at elbow height or slightly lower.

  • Improve your posture. Incorrect posture rolls shoulders forward, shortening your neck and shoulder muscles and compressing nerves in your neck. This can affect your wrists, fingers and hands.

  • Make sure that your computer mouse is comfortable and doesn’t strain your wrist.

  • Keep your hands warm. You’re likelier to develop hand pain and stiffness if you work in a cold environment. Put on fingerless gloves that keep your hands and wrists warm if needed.

 

At the end of the day (at least in the personal experience of your Gazette editor and carpal tunnel patient) life with carpal tunnel syndrome is manageable—so long as you type lightly, regularly stretch and relax those hands, wrists and forearms, and keep prolonged gripping activities to a healthy minimum.