Facts Concerning Carpal Tunnel Syndrome
What is Carpal Tunnel?
Carpal tunnel (median nerve compression) is caused by pressure on the median nerve. There is a narrow passageway that is surrounded by ligaments on the palm side that is surrounded by bones called the carpal tunnel. Compression of the median nerve that runs the length of the arm and through the wrist can cause tingling, numbness and weakness in the arm and hand. There are several possible reasons that may cause this condition.
Carpal tunnel syndrome was described back in the mid 1800s, and the first surgery was done in 1930. It is unusual to get this syndrome before age twenty. This syndrome is the most common problem affecting the hand. This syndrome is thought to affect three to six percent of the population.
Anatomy of the Hand
The bones in the hand include tendons and the median nerve that connects the hand and forearm. The bones actually form a semicircle. There are ligaments on the top of the tunnel, which is a strong tissue holding the tunnel together. The median nerve provides the feeling to all of the fingers, except the little finger, and the thumb. The tendons are rope-like structures that connect the forearm muscles to the hand bones. This allows the thumb and the fingers to bend.
Symptoms of Carpal Tunnel
Repetitive motions, other health problems and the anatomy of the wrist may contribute to this syndrome. Carpal tunnel syndrome typically begins gradually and the discomfort increases. The symptoms include:
- Numbness or tingling - These symptoms may be noticed in the hand or the fingers. The little finger usually does not have these symptoms but the others do, including the thumb. This uncomfortable sensation may be felt from the wrist up the arm. These symptoms are often noticed when driving a car, holding a phone book or newspaper. They can even wake you from sleep.
- Weakness of the hand - There may be weakness of the hand causing you to drop things. There also may be numbness in the hand caused by numbness in your hand.
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Factors That Increase Symptoms
There are several factors that may increase the symptoms of carpal tunnel syndrome. Listed below are factors that do not actually cause the syndrome, but either damage or just irritate the median nerve.
- Anatomical factors such as a wrist fracture or dislocation, arthritis of the small wrist bones can alter the space within the carpal tunnel. Anything that puts pressure on the median nerve can be a factor.
- The syndrome is more common in women possibly because women tend to have a smaller carpal tunnel then men.
- People with inflammatory conditions, such as rheumatoid arthritis, as the inflammatory component puts pressure on the lining around wrist tendons and on the median nerve.
- Obesity is a risk factor.
- Diabetes or other chronic illnesses may damage the nerves.
- Some medications, such as anastrozole (Arimidex), which is a breast cancer treatment.
- Fluid retention can put pressure on the median nerve. Pregnancy can cause fluid retention but this resolves after delivery.
- Particular medical conditions may cause this syndrome, such as menopause, kidney failure, thyroid disorders and lymphedema.
- Some workplace factors, such as working on an assembly line, hours of computer use or using a vibrating tool frequently, can create pressure on the median nerve.
These factors are not considered causes at this time but there is a great deal of research ongoing.
Your doctor will review your symptoms and do a physical examination by testing the feelings in your fingers and the strength of the muscles in your hand. The wrist may be x-rayed to rule out other causes of your discomfort. The pain may be due to a fracture or to arthritis, but carpal tunnel cannot be diagnosed this way
An electromyography is a test that measures tiny electrical discharges produced in the muscles. A thin needle is inserted in specific muscles to evaluate that electrical activity when the muscle is contracted and at rest. This test will identify damage to the muscles that are controlled by the median nerve. A nerve conduction study is another test that evaluates electrical impulses.
You can take breaks more frequently and use ice packs to reduce any swelling. Avoiding activities that make symptoms worse may help. A physician will typically try non-surgical therapy before recommending surgery. Non-surgical treatment is more effective when this syndrome is diagnosed early.
There are several possible treatments for this disorder, including:
Wrist splinting - The splint holds the wrist still when you sleep as that is when the pain is the worst, but it is also good for daytime.
Nonsteroidal anti-inflammatory medications - This includes (NSAIDs), such as ibuprofen (Advil, Motrin IB, etc.). These won’t cure the disorder but only give some relief.
Corticosteroids - Your doctor may use this for an injection and sometimes use an ultrasound to guide the injection. Oral corticosteroids are not as effective unless the cause of carpal tunnel is an antiinflammatory disease, such as lupus or rheumatoid arthritis.
Surgery will be used if there is no response to other treatments. Pressure is relieved by cutting the ligament pressing on the median nerve. There are two types of surgeries.
Endoscopic surgery uses a telescope type of device with a tiny camera to view the carpal tunnel.
Open surgery may be used where the surgeon makes an incision in the palm over the carpal tunnel and the ligament is cut to free the nerve.
The healing process allows the ligament to slowly grow back together to allow more room for the median nerve.
There are no specific proven strategies to prevent this syndrome but you may be able to reduce the discomfort by minimizing the stress on your hands or wrists. These methods include:
- Relax your grip and hit keys softly when you use a computer or a cash register.
- When doing prolonged hand writing use a larger size pen with free-flowing ink.
- Frequent, short breaks are helpful and stretch your hands and wrists. When using vibrating equipment try to alternate tasks when possible.
- A relaxed middle posture is helpful, so avoid bending your waste all the way up or down. Your keyboard should be elbow height or slightly lower.
- Good posture is important, so do not keep your shoulders rolled forward as that may compress the nerves in your neck.
- Use a comfortable mouse that is comfortable so it does not strain your wrist.
- Try to keep your hands warm to avoid stiffness from the cold. Fingerless gloves can also be helpful.
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NIH’s National Center for Complementary and Integrative Health funds numerous studies that study long-lasting neuropathies. They also research biomechanical stresses contributing to nerve damage that is responsible for carpal tunnel syndrome to prevent this disorder.
Carpal tunnel syndrome is a common hand disorder that is painful but there is no cure. There are several possible treatments, but surgery is the only way to stop the discomfort. There is a great deal of ongoing research, so there is hope for the future of this disorder.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2020 Pamela Oglesby