About Carpal Tunnel Syndrome
The carpal tunnel is a narrow passageway in the wrist through which several tendons and the median nerve pass. The tunnel is formed by the carpal bones (hand bones) on the bottom, and the transverse carpal ligament on the top. The purpose of this narrow tunnel is to secure the tendons that flex the fingers; however, in order to do so, the carpal tunnel must form a very tight and narrow area. Because of this, any minor swelling, inflammation, or tightness in the area can result in compression of the median nerve, or carpal tunnel syndrome. 
The classic symptom of carpal tunnel syndrome is a painful burning or tingling sensation in the medial hand, thumb, index, middle, and ring fingers. This is because these regions of the hand are supplied by the compressed median nerve. Other symptoms include sensitivity to touch, weakness in the hand and wrist, as well as radiating pain up the arm. Symptoms generally begin at night, but may worsen and become more chronic with time. Patients commonly report symptoms to be at their worst during activities that require finger flexion, such as gripping a steering wheel or holding a phone. In more extreme cases, patients may lose their ability to distinguish between hot and cold by touch. Risk Factors
- Gender: Women are three times more likely to develop carpal tunnel syndrome than men. Fluid retention associated with pregnancy and menopause can sometimes be a cause of carpal tunnel syndrome.
- Heredity: An individual may have a significantly higher chance of developing carpal tunnel syndrome if he or she has relatives with the condition. This is due to inherited factors such as the shape of the wrist and the size of the carpal tunnel itself. Those with more narrow carpal tunnels are more likely to develop carpal tunnel syndrome.
- Preexisting Health Conditions: Trauma to the wrist, in the form of a strain, sprain, fracture, etc. can sometimes lead to carpal tunnel syndrome. Other health conditions that may predispose an individual include hypothyroidism, diabetes, obesity, rheumatoid arthritis, and end-stage kidney disease. These conditions may cause water retention leading to swelling (and subsequently increased pressure) at the wrist.
- Overuse: A common misconception is that carpal tunnel syndrome occurs as a result of repetitive computer use, though little scientific evidence exists to support this theory. However, some research does suggest that carpal tunnel syndrome can result from overuse in activities that require repetitive forceful or awkward movements of the hand, such as heavy assembly line work and power tool use.
Treatment
- Wrist Splinting: For mild to moderate symptoms, splinting the wrist at night can help relieve symptoms of tingling and numbness. Some patients choose to wear a wrist brace throughout the day as well.
- Pharmacological Treatments: Nonsteroidal anti-inflammatory drugs may be used to treat minor or acute symptoms of carpal tunnel syndrome. These are best used in conjunction with other conservative treatments, as these drugs are rarely enough to treat the condition by themselves. Doctors may prescribe a diuretic (“water pill”) to decrease any swelling due to water retention, or a corticosteroid (either oral or via injection) to relieve pressure on the median nerve and provide a more immediate relief to carpal tunnel syndrome.
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| TENS Treatment |
- Physical or Occupational Therapy: Because carpal tunnel syndrome affects the fine motions of the hand, patients may see either a physical therapist or an occupational therapist as an effective form of treatment. Therapy sessions may include heat and ice treatments, as well as exercise regiments custom-tailored to the individual. In the case of physical therapy, ultrasound or transcutaneous electrical nerve stimulation (TENS) may be used to alleviate nerve symptoms. These treatments involve the placement of electrodes on the skin, and can serve as a painless moderately effective way of treating carpal tunnel syndrome.
- Surgery: If carpal tunnel symptoms persist for more than six months, surgery may be the best treatment option. Carpal tunnel release surgery is one of the most common surgical procedures in the United States, and has a very high rate of success. It is a simple surgery, involving cutting the transverse carpal ligament to relieve pressure on the median nerve. This procedure can be, but is not always, performed with endoscopic technology. The recurrence of carpal tunnel syndrome after this surgery is rare, as the majority of patients recover completely.
An Ounce of Prevention
For individuals who are predisposed, either genetically or by a preexisting health condition, carpal tunnel syndrome may be difficult to prevent. For those who work in environments that require overuse of the hands and wrists, taking frequent breaks and performing stretching and strengthening exercises a few times a day may decrease the risk of developing carpal tunnel syndrome.
Sources and Additional InformationMayo Clinic http://www.mayoclinic.com/
National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/
Lippert, Clinical Kinesiology and Anatomy, 4th edition
National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/
Lippert, Clinical Kinesiology and Anatomy, 4th edition