Carpal Tunnel Syndrome

You're typing away at your desk and suddenly feel a sharp pain in your wrist, shooting into your thumb and hand. You take a small break and stretch your wrists, but it doesn't go away this time. It's quite possible that you are developing carpal tunnel syndrome - a neuropathy (nerve disorder) that often strikes people whose occupation requires frequent hand usage or vibrational machines.

What is carpal tunnel syndrome?

Carpal Tunnel Syndrome (CTS) is a painful and often debilitating disorder affecting the hands and wrists. The symptoms of carpal tunnel syndrome include numbness and tingling in the hands, primarily the thumb and thumb pad, index, middle, and inner half of the ring fingers. Many sufferers of CTS report increased symptoms at night, making sleep difficult. Advanced stages of carpal tunnel syndrome result in decreased fine dexterity movements of the fingers, such as buttoning a blouse, and reduced grip strength. Also, the thenar pad (palms) may undergo muscle atrophy (shrinking).

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Carpal Tunnel Syndrome occurs when the median nerve, one of the major nerves that supplies the upper extremity, is compressed in the carpal tunnel: a narrow passageway in the wrist formed by the carpal bones and the transverse carpal ligament- a strip of tendon that supports the wrist from the bottom.

The contents of the carpal tunnel include the median nerve and the flexor tendons of the wrist and fingers (the tendons that enable you to form a fist). Carpal tunnel syndrome is often the result of a combination of factors that press on the median nerve and tendons in the carpal tunnel. The disorder can also be due to a congenital (born with) predisposition where the carpal tunnel is smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems of the carpal (wrist) bones; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. In some cases no cause can be identified.

How is carpal tunnel syndrome diagnosed?

By the time you feel neuropathic symptoms (numbness, pins and needles, loss of grip strength), it usually means that the median nerve is under compression in the wrist, and possibly at the nerve root level in the neck. The first order of business is to schedule an appointment with a specialist who treats carpal tunnel syndrome.

There are a few simple orthopedic test that can be useful for diagnosing CTS. The first is called Tinel's test: with the tip of your middle finger, firmly tap the underside of the wrist in the suspected hand 3-5 times. If this tapping causes a sharp pain to travel into the palm, thumb or index finger, it is a sign of carpal tunnel syndrome. The second test is called Phalen's maneuver: simply press your hands in front of you as in a prayer, and hold for 15 seconds. If you feel tingling or numbness in your affected hand, it is also a sign of CTS. The thumb opposition test is done by pinching together your thumb and small finger. If someone can separate them with little effort, it suggests denervation (median nerve-thenar branch) of the thenar (thumb pad) muscle, another sign of CTS.

The definitive diagonsis for CTS is if the symptoms of numbness and tingling affect the thumb, index, middle, and inner half of the ring finger, and if the numbness and tingling is strong enough to keep you awake at night.

A physician/ hand specialist may order a nerve conduction study that measures nerve conductivity of the median nerve. This can be helpful in the diagnosis, although it may produce false negative tests.

How do I prevent getting carpal tunnel syndrome?

It is best to take a proactive stance so as not to develop carpal tunnel syndrome in the first place.  Activites that are known to lead to carpal tunnel syndrome include:

• Computer keyboarding
• Hard gripping (machines, etc.)
• Assembly
• Pulling/Pushing heavy items
• Carrying things with wrist extended (waitressing)
• Using vibrational equipment

Giving your hands a rest every few minutes is important.  If your job involves a lot of time typing, make sure that your workstation is set up ergonomically:  monitor at eye level; keyboard tray to allow arms to fall naturally to your side while typing; and a chair with good back support, and foot stool to take some pressure off your thighs.  Keep your elbows at a 90-100 degree bend and keep your wrists straight, inline with your forearms.  Keep your mouse and other accessories within a small arc from your keyboard to minimize repetitive reaching.  Lastly, stretch your wrists, shoulders, neck and back every hour. If at all possible, try to rotate tasks every other month to avoid repetitive stress to your wrists.

How is carpal tunnel syndrome treated?

For early stage carpal tunnel syndrome, rest is prescribed (work limitations) as well as a short course of anti-inflammatory medication like motrin or ibuprofen. Hand and wrist stretches are helpful to increase circulation to the wrist tendons. Wrist braces or wrist splints may be prescribed as well, especially if the patient has a habit of flexing the wrists during sleep.

The next level is physical medicine: chiropractic and modalities, physical therapy, occupational therapy.

The next level of intervention is cortisone injections into the carpal tunnel. Cortisone is a powerful anti-inflammatory medication. If successful, the injection can reduce pain for months. However, the danger of this is that the patient, being pain free may continue to overuse the hands, causing CTS to reappear more severely.

The next level of intervention is surgery. The two basic types are standard sugery where local anesthesia is applied to the wrist, and an incision is made over the transverse carpal ligament. The ligament splits and creates more space for the median nerve. The skin is stitched closed, and scar tissue fills in the gap, reconnecting the ligament. The second type is endoscopic surgery, which uses an endoscope and microscalpel to perform the incision. This method results in less destruction to adjacent tissues. Surgery has mixed results, with some patients getting long term relief and others getting no relief, and in some cases, having complications from the procedure.

It is important that you see a carpal tunnel syndrome doctor; i.e. one who has experience in this particular disorder so that the proper treatment or remedy can be determined, as each case is different.

We have several therapeutic approaches to treating carpal tunnel syndrome, including Inter-X active stim, Solaris light-wave therapy, endermotherapy, active release technique, joint mobilization, chiropractic extremity manipulation, and traction. Call us for a complimentary evaluation.

Note: carpal tunnel syndrome is somtimes misstakenly spelled carpel tunnel, corpal tunnel, and carple tunnel syndrom.

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