About Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) squeezes or presses the median nerve at the wrist (running from the forearm into the palm). Carpal tunnel is a rigid narrow passageway at the wrist housing the median nerve and the finger flexor tendons. The median nerve supplies the lateral 2/3rd of the palm (the thumb, index, middle, and part of the ring fingers). Narrowing this tunnel secondary to swelling or thickened lining of the irritated tendons compresses the median nerve, resulting in weakness, numbness, or swelling in the hand/wrist, or sometimes even up to the forearm and arm.
Signs and Symptoms of CTS
It usually has a gradual onset of symptoms with tingling, numbness or burning in the palm and fingers (lateral 2/3rd of palm as noted above). Symptoms usually initially appear in the night (due to bent wrist during sleep). However, it may cause an awakening in the night. The symptoms gradually develop in the daytime as well. Symptoms are often noted as severe by people engaged in manufacturing/assembly line, or who do a lot of typing. Grip strength decreases the ability to grasp small objects, precision handling of things, making a fist or other tasks. This leads to difficulty in the activities of daily living and job responsibilities. If not treated, chronic cases may observe wasting of the muscles at the base of the thumb (the thenar eminence). The sensation may also be affected in some cases.
What causes CTS, and who is at risk?
CTS may be caused secondary to an injury to the wrist causing swelling, thus narrowing the carpal tunnel. Injury can be a sprain/fracture. It can also be caused due to degenerative changes, as in rheumatoid arthritis. Other mechanical causes can be a repetitive use of vibrating hand tools, jobs requiring repetitive movement of wrists, occupational stress, and overpressure on the wrists, hands, and fingers. In these cases, onset is gradual, and the condition often becomes chronic. Some other rare causes are the presence of cyst/tumor in the canal or fluid retention during pregnancy or menopause. Due to varied reasons and a common manifestation, it is difficult to identify the cause. CTS is usually noted in adults.
Women are more than twice more likely to develop CTS than men (the carpal tunnel may be smaller in women). Dominant hand usually gets affected first, and the symptoms are more severe. Disease conditions like diabetes affect the peripheral nerves, making the patient more susceptible to compression. The risk of developing CTS is not limited to people with any single industry/job, however, it is more common in those employed in assembly line work involving finishing, packing, manufacturing, sewing, and any precision handling. As observed in a few studies, CTS is three times more common in assembly-line people than entry/typing.
Diagnosing CTS
Medical history and physical examination, including special orthopedic tests, imaging studies including x-rays and ultrasounds, electrodiagnostic studies including electromyogram and nerve conduction study, and laboratory tests are the ways CTS can be diagnosed.
Treating CTS – The Appropriate approach
Let us now begin with the treatment of carpal tunnel syndrome. Early diagnosis is always helpful inappropriate treatment. The first line of treatment should always focus on conservative management, including:
- • It was splinting at night, avoiding further narrowing of the tunnel and preventing irritation to the median nerve.
- • Avoiding/minimizing activities aggravating symptoms. Taking rest/stretch breaks at work may help. Applying cold packs can help in reducing swelling if present.
- • OTC drugs/NSAIDs may help provide short-term relief from pain and swelling.
- • Treatment including physical therapy, occupational therapy, acupuncture, or yoga can be helpful.
- • A home exercise program suggested by a PT/OT can prove helpful
- • Prescription medications (such as prednisone) by your doctor or a specialist
- • Any possible secondary/underlying cause (such as diabetes or arthritis) should be identified and treated accordingly
Surgical management should be the last resort if nothing else is proving to help relieve the symptoms. Surgery may include the available release or endoscopic surgery. Surgical management has its own pros and cons so it is necessary to decide the line of treatment after factoring in all the possibilities.
Preventing CTS in an easy way
Ergonomic adjustments are the key to preventing and treating CTS at work. On-the-job conditioning, stretching and other exercises, rest breaks, positioning of wrist, and posture maintenance are the ways to prevent CTS. In addition, regular stretching and exercising the structures around the wrist can be helpful in daily routine.
The better understanding we have of Carpal Tunnel Syndrome, the better we can manage/prevent the condition ourselves.
