HEALTH and WELLNESS
 

Carpal Tunnel Syndrome

                                                                                Cross Sectional view of the Wrist

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a medical condition characterized by chronic pain, paresthesias, and muscle weakness in the forearm and hand.  The carpal tunnel is composed of three sides of bone and a fibrous sheath on the fourth, that enclose the median nerve, which is responcible for feeling in the thumb, index, middle, and ring fingers; and nine different tendons that are responcible for moving the hand.  Carpal tunnel syndrome occurs when this tunnel is decreased in size or when the contents of the tunnel swell.  In both cases the result is the same as compression of the median nerve leads to the pain, paresthesias, and weakness caused by Carpal tunnel syndrome.

How does Carpal Tunnel Syndrome Occur?

Carpal tunnel syndrome is caused by repetetive hand movements in which the wrist is bent at an angle.  Most cases of Carpal tunnel syndrome occur in office jobs or industrial occupations and is more common in women than men.  Carpal tunnel syndrome may also be caused by an injury to the wrist, such as a fracture, or it may be caused by a disease such as diabetes, rheumatoid arthritis or thyroid disease. Symptoms develop gradually, however, the onset of carpal tunnel typically occurs at night due to the fact that many people sleep with their wrists bent, which further compresses the carpal tunnel and your hand feels like its “falling asleep.”  Symptoms include:

• Numbness or tingling in your hand and fingers, especially the thumb, index, and middle fingers.

• Pain in your wrist, palm, or forearm.

• More numbness or pain at night than during the day. The pain may be so bad it wakes you up.

• You shake or rub your hand to get relief.

• More pain when you use your hand or wrist more.

• Trouble gripping objects.

• Weakness in your thumb.

How do I know if I have Carpel Tunnel Syndrome?

In order to diagnose Carpal tunnel syndrome your doctor will ask questions about your symptoms as well as a physical examination of your hand.  The doctors will perform:

• Phalen's Maneuver- Flexing the wrist gently as far as possible, then holding this position and awaiting symptoms.

• Tinel's Sign- Light tapping of the area over the nerve to elicit a sensation of tingling or "pins and needles" in the nerve distribution.

• The Carpal Compression Test- Applying firm pressure of the palm over the nerve to elicit symptoms.

• Nerve Conduction Test or an Electromyography (EMG) Test to see whether the nerves and muscles in your arm and hand show the typical effects of carpal tunnel syndrome.

How can I treat Carpal Tunnel Syndrome?

Carpal tunnel syndrome usually is not serious. With treatment, the pain will usually go away and you will have no lasting damage to your hand or wrist. Your doctor may prescribe physical therapy, as well as over the counter anti-inflammatory and pain relievers and/or cortisone injections.  At physical therapy  soft tissue massage, conservative stretches and exercises, splints, and techniques to directly mobilise the nerve tissue.  At home one should:

• Prop up your arm with pillows when you lie down.

• Avoid using your hand too much.

• Find a new way to use your hand by using a different tool.

• Try to use the other hand more often.

• Avoid bending your wrists down for long periods.

In severe cases of Carpal tunnel syndrome surgery may be required to treat the injured wrist.  There are two kinds of surgery available, pen surgery or endoscopic surgery, and Carpal tunnel syndrome surgery has a 90% or higher success rate.

Splint used for bracing the wrist

Can Carpal Tunnel Syndrome be prevented?

The good news is Carpal tunnel syndrom can be prevented. Follow these simple tips for healthier wrists:

• Lose weight if you are overweight.

• Get treatment for any disease you have that could cause carpal tunnel syndrome.

• If you do the same tasks with your hands over and over, try not to bend, extend or twist your hands for long periods.

• Do not work with your arms too close or too far from your body.

• Do not rest your wrists on hard surfaces for long periods.

• Switch hands during work tasks.

• Make sure your tools are not too big for your hands.

• Take regular breaks from repeated hand movements to give your hands and wrists time to rest.

• Do not sit or stand in the same position all day.

• If you use a keyboard a lot, adjust the height of your chair so that your forearms are level with your keyboard and you do not have to flex your wrists to type.

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