How to care for Carpal Tunnel Syndrome - January 2022

By OK In Health's Articles

carpal tunnel

Carpal tunnel syndrome, also known as (CTS) and median nerve compression, is a common condition that causes numbness, tingling, and pain in the hand and arm. It occurs when the median nerve, which runs from the forearm into the palm, is compressed or squeezed as it runs through a passageway or tunnel called carpal tunnel at the wrist. This narrow, rigid tunnel is formed at the bottom and sides by the carpal or wrist bones (hence the name carpal tunnel) and at the top or roof by a thick band of ligament. Inside, the tunnel houses the median nerve and the tendons that bend the fingers. The median nerve provides sensation (ability to feel) to the palm side of the thumb, index finger, middle finger, and part of the ringer finger, although not the little finger or the “pinky.” It also controls movements around the base of the thumb. 

What are the symptoms of carpal tunnel syndrome?
Carpal tunnel syndrome is aptly named a syndrome because you may experience several symptoms simultaneously. The word syndrome comes from the Greek meaning running together - a group of symptoms running or occurring together that characterize a particular abnormality or condition. Carpal tunnel syndrome symptoms usually start gradually and may include:

Numbness, tingling and/or pain primarily in the thumb, index, middle, and ring fingers but not the little finger. The median nerve provides sensation (ability to feel) only to your thumb, index finger, middle finger, and part of the ring finger. These symptoms can appear in one or both hands, but the dominant hand is usually affected first and often most severely. Because some people sleep with their wrists bent or curled, these symptoms are often first reported at night and can wake people from sleep. During the day, these symptoms often occur when holding something with a bent wrist, such as when holding a book, steering wheel, or phone.

Early on in the condition, symptoms come and go, and many people find that shaking out their hands helps relieve their symptoms. However, symptoms can become more persistent over time. Weakness in the hand, dropping objects, and inability to perform delicate tasks: symptoms become more constant as the condition worsens. You may experience weakness in your hand and drop things, possibly due to numbness of the hand and/or weakness of the thumb’s pinching muscles controlled by the median nerve. In severe cases, the muscles at the base of the thumb become weak and shrink in size, causing you to have less grip strength. Hand weakness may also make it difficult to perform specific fine movements such as buttoning your clothes.

What causes carpal tunnel syndrome?

Because the boundaries of the carpal tunnel are very rigid (carpal or wrist bones at the bottom and sides of the tunnel and a thick band of ligament at the top of the tunnel), the carpal tunnel has little capacity to stretch or increase in size. Carpal tunnel syndrome occurs when this tunnel becomes narrowed (e.g., due to a wrist fracture) or the tissues surrounding the tendons housed inside the tunnel become inflamed and swollen (e.g., due to rheumatoid arthritis). These changes put pressure on the median nerve, thereby compressing or squeezing it. 

Who is at risk for carpal tunnel syndrome?
Anything that squeezes or irritates the median nerve may lead to carpal tunnel syndrome. However, there is no single cause of carpal tunnel syndrome in many cases. Instead, it is a combination of risk factors that contributes to its development, and these include:

Sex: Women are three times more likely to develop carpal tunnel syndrome than men, possibly because women tend to have smaller carpal tunnels than men.

Heredity: Smaller carpal tunnels tend to run in families.

Anatomical factors: Any anatomical factors that narrow the space within the carpal tunnel (e.g., a wrist fracture or dislocation or arthritis) can put pressure on the median nerve.

Nerve-damaging conditions: Some chronic diseases such as diabetes can cause damage to nerves, including the median nerve in the carpal tunnel.

Inflammatory conditions: Inflammatory conditions such as rheumatoid arthritis can inflame and cause swelling to the tissues surrounding the tendons in the carpal tunnel resulting in the compression or squeezing of the median nerve.

Other medical conditions: Certain conditions such as thyroid disorders, kidney failure and lymphedema may increase the risk of developing carpal tunnel syndrome.Body fluid changes: Body fluid retention during pregnancy or menopause can increase the pressure inside the carpal tunnel and irritate the median nerve. Carpal tunnel syndrome associated with pregnancy often disappears after pregnancy. 

Obesity: Being obese increases the risk of developing carpal tunnel syndrome.

Medications: Certain medications such as anastrozole, a drug used to treat breast cancer, are linked with the development of carpal tunnel syndrome.

Workplace factors: Occupations that involve repetitive or prolonged flexing of the hand or wrist, such as an assembly line worker, sewer, cashier, or musician, may aggravate the tendons in the carpal tunnel causing swelling and pressure on the median nerve, especially if working in a cold environment. Several studies have evaluated whether there is an association between keyboard/mouse use and carpal tunnel syndrome. Some studies point to mouse use as the culprit and not a keyboard. However, the evidence is inconsistent and is not of the same high quality. More studies are needed to support keyboard/mouse use as a risk factor for carpal tunnel syndrome.  

How is carpal tunnel syndrome diagnosed?
Your doctor will typically make a diagnosis after asking about your symptoms, doing a physical examination of your hand and wrist, and performing several tests including:

Tinel’s sign: Your doctor taps your median nerve at the wrist to see if it produces a tingling sensation at the fingers.

Wrist flexion test (or Phalen test): Your doctor asks you to rest your elbows on a table and have your wrists fall forward freely. Those with carpal tunnel syndrome will experience numbness and tingling in the fingers within 60 seconds. The more quickly these symptoms appear, the more severe the carpal tunnel syndrome.

X-rays: Your doctor may order an X-ray of your wrist to reveal fractures, arthritis, and nerve-damaging diseases such as diabetes.

Electromyography (EMG) and nerve conduction studies: Your doctor performs these tests to see how well your median nerve is working and how well it controls muscle movement.

How is carpal tunnel syndrome treated?
The treatment for carpal tunnel syndrome will depend on your symptoms and how far your condition has progressed. Treatment may include:

Lifestyle changes: If a repetitive and prolonged motion is the primary source of your symptoms, take frequent short breaks and, if possible, stop or do less of the activity that is causing your symptoms.

Exercises: Stretching or strengthening exercises can improve symptoms, and nerve gliding exercises can help the median nerve move better within your carpal tunnel.

Immobilization: Your doctor may ask you to wear a splint to prevent wrist movement and relieve some pressure on your nerves. You may wear one at night to help you get rid of numbness and tingling and to help you sleep better.

Medication: Your doctor may prescribe you some anti-inflammatory drugs or steroids to reduce inflammation and swelling.

Surgery: If none of the other treatments works, your doctor may recommend having an operation called carpal tunnel release to increase the size of your carpal tunnel and ease the pressure on your median nerve. 

How can carpal tunnel syndrome be prevented?

Take frequent rest breaks from repetitive activities.

Stretch your wrists gently between repetitive activities.

Keep your wrist straight when using tools.

Avoid flexing and extending your wrists repeatedly.

Use correct posture and avoid bending your wrists all the way up or down.

Keep your hands warm. You are more likely to develop hand pain and stiffness by working in a cold environment. Wear fingerless gloves to keep your hands and wrists warm if you cannot control your work temperature. Monitor and treat medical conditions associated with carpal tunnel syndrome (e.g., control your diabetes to prevent damage to your median nerve).

While prevention is always far better than treatment, if you experience any symptoms of carpal tunnel syndrome, see your health care professional as soon as possible as permanent nerve and muscle damage can occur without treatment. 

Sources:  University of Victoria, bc, Mayo Clinic website, The Academy of Orthopaedic Surgeons Ortho Info website, WebMD website, National Institutes of Health National Institute of Neurological Disorders and Stroke handout, Cleveland Clinic website, Johns Hopkins Medicine website, Canadian Centre for Occupational Health and Safety website, American Society for Surgery of the Hand website, Healthline website  

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