Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
The carpal tunnel is a narrow, rigid passageway of ligament and bones at the base of the hand that holds the median nerve and 9 tendons of the fingers. Carpal tunnel syndrome (CTS) occurs when the median nerve becomes pressed or squeezed within the carpal tunnel. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as some movements of the fingers and thumb. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed, resulting in pain, weakness, or numbness in the hand and wrist. Pain may radiate up the arm as well.
Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the tingling and numbness and restore wrist and hand function.
Common Causes
In general, anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. In many cases, no single cause can be identified, although certain things are thought to increase the risk of CTS developing, such as:
- family history/congenital predisposition - the carpal tunnel is simply smaller in some people than others
- pregnancy – up to about 50% of pregnant women develop CTS
- sex - CTS is generally more common in women
- injuries to the wrist that cause swelling or narrowing of the carpal tunnel
- other health conditions, such as diabetes and rheumatoid arthritis
- strenuous, repetitive work with the hand
- repeated use of vibrating hand tools
Signs & Symptoms
The symptoms of CTS tend to develop gradually and usually start off being worse at night or early in the morning. The three main symptoms are:
- tingling
- numbness
- pain
- hand weakness
However, the tingling, numbness and pain can sometimes extend up the forearm.
The symptoms of CTS are often worse after using the affected hand. Any repetitive actions of the hand or wrist can aggravate the symptoms, as can keeping your arm or hand in the same position for a prolonged period of time.
Treatment
Carpal tunnel syndrome should be treated as early as possible after you begin to experience symptoms. Underlying causes such as diabetes or arthritis should be treated first. Try the following techniques to reduce your symptoms. If these techniques don't offer relief within a couple weeks, consult your doctor or physiotherapist.
1. Avoid activities and positions that worsen symptoms, such as repetitive hand work and bending the wrist. Take frequent breaks to rest your wrist and hand. This is the most important form of treatment!
2. Wear a splint that prevents your wrist from bending, especially at night. Wrist splints are generally available over-the-counter at most drugstores or pharmacies. The splint should be snug but not too tight.
3. Ice for 10 minutes at a time if there is swelling and the wrist is warm to touch. Wait at least 1 hour before icing again.
4. Anti-inflammatory meds - ask your family doctor or pharmacist if it is safe for you to take an anti-inflammatory medication such as ibuprofin.
5. Stretches - Take breaks throughout the day to do some wrist flexion and extension stretches. Don't push them too far, if it hurts - back off a bit. You can also get a stress ball or something similar to squeeze throughout the day.
Surgery
If your symptoms are severe or persist after trying nonsurgical therapy, surgery may be the most appropriate option. The goal of carpal tunnel surgery is to relieve pressure on your median nerve by cutting the ligament pressing on the carpal tunnel. Make sure to discuss the risks and benefits of surgery with your doctor before surgery.