Carpal Tunnel Syndrome

The human wrist contains a strong, fibrous sheath of tough connective tissue, the flexor retinaculum, which envelops and protects several arrangements of bone. The carpal tunnel is the space between this sheath and the bones making up the wrist and hand. The carpal tunnel houses one nerve, the median nerve, which becomes compressed and causes carpal tunnel syndrome.

The median nerve controls sensation and small muscles in the thumb, index finger, and middle finger. Carpal tunnel syndrome is a medical condition in which the median nerve is compressed at the wrist. [5] This stress on the nerve leads to pain, numbness, and muscle weakness in the forearm and all fingers in which the median nerve plays a part. Symptoms start gradually and also include frequent burning, tingling, and itching in the palm of the hand and fingers. Many of these symptoms are apparent at night because many people sleep with bent wrists, compressing the carpal tunnel. Fingers may feel swollen, even though little or no swelling is apparent.[7] Many sufferers of carpal tunnel syndrome have a decrease in grip strength and have difficulty forming a fist. In severe cases, some may be unable to differentiate between hot and cold touch and the thenar muscles, those which are connected to the thumb, may atrophy.[5]

Repetitive activities are often blamed in the progression of carpal tunnel syndrome, but many cases of carpal tunnel syndrome have no known cause. Another cause is the size of the wrist and a history of carpal tunnel running in one's family.[6] Some may have been born with a carpal tunnel or wrist that is smaller than average. Trauma to the wrist, stress, a sprain or fracture, and other diseases may also increase an individual's susceptibility. Related trauma may be a dislocation of one of the carpal bones of the wrist, strong blunt trauma, a hematoma inside of the wrist, or an abnormal healing of a previous fracture. Swelling and fluid retention can cause the median nerve to become compressed, which is why many women who are pregnant experience carpal tunnel syndrome. Hypothyroidism, diabetes, rheumatoid arthritis, and work stress are also related causes of CTS symptoms. Some studies have found correlation between carpal tunnel syndrome and a variety of psychological and social factors in the workplace.[1][2][6]

A diagnosis of carpal tunnel syndrome can be obtained through a number of tests. One of these is called Phalen's maneuver. It is performed by gently flexing the wrist as far as it will go and waiting for symptoms to appear. If numbness or tingling do not appear within sixty seconds, carpal tunnel syndrome is not apparent. The quicker symptoms appear, the more advanced the condition. Another test, called Tinel's sign, is performed by tapping the area of the median nerve to provoke tingling.[8] A doctor must also test for other medical conditions to make sure that the numbness and tingling is CTS and not a different medical problem.[3]

There are many options for effective treatment of carpal tunnel syndrome. Starting treatment early, before the condition advances, is always effective in preventing it from appearing again. One common treatment of CTS is rest. Resting the affected hand for at least two weeks with the use of an immobilizing brace. These can be especially effective during sleep and during activities which contribute to CTS. This keeps the wrist straight and prevents any physical compression of the carpal tunnel. Taking breaks while participating in activities that provoke symptoms and changing the ergonomics of one's work place has shown to be an effective treatment. Additionally, anti-inflammatory medication such as ibuprofen and vitamin B6 supplements may be prescribed.[6][4]

Physical therapy such as soft tissue massage, small stretches, and exercises are effective in reducing symptoms. Steroid injections can be a temporary treatment for pain associated with carpal tunnel syndrome. Physicians only prescribe steroid injections as a hold over while other treatment options are being identified. In most patients who require these injections, the only permanent relief is surgery