What is Carpal Tunnel Syndrome?

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Three or four decades ago, if you would have asked the average person on the street what carpal tunnel syndrome was, I doubt if too many would have known what you were talking about. This is a new malady, a casualty of the information age and the personal computer, right? Well, yes and no. The name carpal tunnel is fairly new, but the condition isn’t. It can be found in medical records dating back to the early nineteen hundreds.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is a condition caused by the compression of a major nerve that supplies both motor and sensory function to most of the hand. The carpal tunnel is a relatively narrow passageway that is located on the bottom (palm) side of your wrist. Along with the median nerve discussed above, the carpal tunnel is home to nine tendons that are responsible for the ability to bend your fingers. All of these tissues are funneled through this tunnel that is about as big around as your thumb. When all systems are go, this arrangement works fine, but since the carpal tunnel is so narrow, any swelling or pressure on the median nerve and/or the tendons inside it can cause considerable problems for the hand and wrist.

CTS affects women about three times more often than men, and women between the ages of 30-60 have the highest incidence. Senior men also have a higher rate than younger men. Carpal tunnel and its cousin repetitive motion injuries are very common problems in the workplace, and it is estimated that their cost for lost work time is close to $300 million annually.

What Are the Signs and Symptoms of Carpal Tunnel Syndrome?

The first sign for most CTS victims is a vague aching in the wrist that sometimes extends into the hand or forearm. Other commonly found symptoms may include:

Shooting pain that can range all the way up the arm, and back down into the hand and fingers. This is normally experienced on the palm side, and usually after forceful use of the muscles in the area.

Weakness of the muscles in the hand and wrist which often results in dropping things and not being able to perform normal everyday tasks, such as removing the lid from a jar.

Chronic loss of feeling in some fingers, or even persistent paralysis of certain parts of the hand. These two symptoms are typically only found in advanced cases.

If left untreated, the muscles of the hand that are serviced by the median nerve can begin to shorten (atrophy) due to lack of use. This phenomenon typically affects the fleshy part of the thumb most often.

What Are the Causes of Carpal Tunnel Syndrome?

Compression of the median nerve can be caused by a variety of situations. Swelling or fluid retention is the most common cause, specifically swelling of the lining and lubricating layer of the tendons, known as the synovium. Some common triggers include:

  • Pregnancy: The fluid retention associated with pregnancy can often lead to swelling in the carpal tunnel. The good news is that in the majority of cases, once the mother has given birth, the situation returns to normal.
  • Other medical conditions: The most common include hormonal disorders such as menopause, rheumatoid arthritis, diabetes, and thyroid disorders.
  • Repetitive use: Repetitious actions, especially those that put a strain on the hands or wrists, can cause irritation and swelling in the carpal tunnel area. When this is the cause of CTS, it is referred to as repetitive motion injury. This is one of the more common disabilities or reasons for time off work in many industries, especially things like heavy assembly line work, or the use of vibrating hand-held tools such as chainsaws, jackhammers, or other power tools. Repetitive motion injury is also common in typists or computer keyboard workers, and in some musicians that use their hands repeatedly, such as guitarists or drummers, for example.
  • Trauma: Injury to the hand or wrist can weaken it, and make a person more susceptible to CTS. For example, a sprained or fractured wrist can result in problematic swelling that could lead to CTS.
  • Physical build: If you are of a small stature or small-boned, you may also have an abnormally narrow carpal tunnel as well. This can lead to a greater risk for CTS.
  • Heredity also seems to play a role, although it is not certain exactly how. If CTS runs in your family, you have a greater chance of developing it yourself. This could be related to things like the inherited shape of your wrist or size of your carpal tunnel.
  • Obesity is also considered a risk factor, as it is for so many other health conditions.
  • Smoking: Individuals who smoke tend to have more intense symptoms with CTS, and their recovery time is longer than that of nonsmokers.

How is Carpal Tunnel Syndrome Diagnosed?

Most folks are first tipped off that they have CTS when activities that they normally do on a daily basis become difficult or painful. We take things for granted, like gripping a steering wheel while driving, or using a computer keyboard, or lifting heavier items like a gallon of milk or laundry detergent. It seems we’ve done them a million times throughout our lives, so when they cause problems, it is our bodies talking to us, giving us the pain message to let us know something is wrong.

The symptoms associated with CTS can be shared by other ailments, such as arthritis, for example. But there are some clues that can help us to determine if it is indeed CTS we are struggling with:

  • If the “outside” of your hand is affected (little finger, and the side of the ring finger nearest the little finger), the problem may be something other than CTS. The median nerve does not affect these parts of the hand, so this is a pretty definitive clue.
  • Consider the timing when you experience symptoms as well. Many CTS patients have somewhat predictable patterns of when they typically have pain or numbness. Waking up with signs in the middle of the night is a common example. Others include relatively effortless actions such as holding a newspaper or a telephone.
  • One test that you can self-administer may help determine CTS. Try holding your hand in a position with the wrist bent for about a minute. If your symptoms materialize, this may indicate carpal tunnel syndrome.
  • Other tests and procedures can be done by your health practitioner. Diagnosis often involves performing a series of simple actions that indicate the general strength of the muscles in the hand, and also check for tingling or numbness. More technical examinations can include tests that measure the electrical impulses in your hand muscles and can give information regarding muscle damage, if it exists. This test is called an electromyogram. Another diagnostic procedure is called nerve conduction studies. This measures the speed that nerve impulses travel through the median nerve. Both of these tests can be useful at both identifying CTS, and ruling it out. For example, the results may indicate the problem is something like a pinched nerve or another neurological problem.

How Can I Prevent or Treat Carpal Tunnel Syndrome?

The best way to prevent CTS is to live a healthy active life with adequate exercise and a good diet, in order to stay well and avoid many of the diseases that can bring on such things as CTS. Staying well is the name of the game, not treating sickness. However, none of us bat a thousand when it comes to our health; so if you are suffering from CTS, let’s discuss a few of the treatment possibilities.

There are, of course, typical allopathic treatments available, which not surprisingly include drugs and surgery. One of the most popular is the use of corticosteroids, either injected into the hand, or taken orally. I would definitely stay away from these dangerous drugs. They are only a band-aid to temporarily remove pain, and the possible side effects are generally not worth the risk. Surgical options may be appropriate in some cases, but consider carefully before you choose surgery. I would not undergo any surgery unless I got several opinions, and even then I would consider it a last choice.

One of the most practical and non-invasive ways to deal with carpal tunnel syndrome is to avoid the activities that are bringing on the symptoms, at least until you have a chance to heal. I realize this is not always an option in some situations. Many folks find success in wearing a splint while working or sleeping, or both. These specially designed wrist splints can give a significant amount of support to the wrist and hands. The best thing to do is to splint early in the process. If you are experiencing initial symptoms, splinting and resting from activities will make it much more likely that the CTS will not advance. These treatments are much more affective early on.

Other therapeutic choices that may help include: Hydrotherapy: This can be as simple as soaking your hands in a tub of warm water. Heat from a heating pad or hot water bottle can also provide some relief. Massage can also be very soothing to sore hands and wrists.

It can be very frustrating and disheartening to suddenly not be able to carry on in the daily activities of life without pain and weakness. But all is not lost. Just remember that the earlier you take proactive measures to deal with the CTS, the greater your chance of returning to a normal level of functioning. Make the necessary corrections, and let your body do what it is so wonderfully designed to do: heal itself.

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