Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a common and often disabling condition that can affect anyone who performs repetitive hand motions. CTS is caused by compression of the median nerve. On its way to the hand, the median nerve passes through an opening in the wrist called the carpal tunnel. Constant, repetitive hand motion may aggravate the ligaments and tendons encased in the tunnel, causing them to swell. As the tunnel walls close in, they compress the median nerve. This causes tingling and numbness in the thumb, index finger, middle finger, and part of the ring finger. The discomfort of CTS often wakes people during the night and eventually makes it difficult to grasp small objects.

CTS is sometimes associated with data entry and general computer use, though studies do not show that specific job-related functions are a cause. Paying attention to proper ergonomics can help prevent CTS. This might involve repositioning a computer keyboard or taking breaks more often. CTS occurs in women more often than men and can be a temporary complication of pregnancy, due to fluid retention. CTS also occurs frequently in people with rheumatoid arthritis or diabetes.

Carpel Tunnel Syndrome

Symptoms

Symptoms of Carpal Tunnel Syndrome may include:

• Tingling, burning, or numbness, especially in the thumb and index or middle fingers
• Pain or numbness that worsens with:
  • Wrist, hand, or finger movement
  • Sleep (symptoms may wake you)
• Hand stiffness or cramping that gets better after:
  • Shaking the hand
  • Waking up in the morning
• Weakness or clumsiness of your hand
  • Loss of grip strength
  • Difficulty touching your little finger with your thumb
  • Frequently dropping things
• Pain extending up your arm

Causes of CTS

Anything that causes irritation, inflammation, fluid retention, or an abnormal growth in or around the carpal tunnel can cause CTS, including:

• Repetitive movements of the hands, wrists, or fingers—sometimes associated with overactive use of a computer keyboard, certain musical instruments, or hand tools
• Use of vibrating equipment or tools
• A narrow carpal tunnel (due to heredity or other causes)
• Wrist injuries like burns, broken bones, or compression and crush injuries
• Arthritis that causes swelling within the carpal tunnel
• Diabetes
• Raynaud's Disease, which impairs blood flow in the hands
• Water retention due to kidney disease, amyloidosis, or coronary artery disease
• Hormone-related conditions, such as:
  • Pregnancy
  • Breastfeeding
  • Menopause
  • Hypothyroidism
  • Cushing's disease
  • Excess growth hormone
• Medications like birth control pills, cortisone pills or shots, and some high blood pressure drugs
• Tumors and cysts in the carpal tunnel

Diagnosis

In order to determine if you have Carpal Tunnel Syndrome, your doctor will ask about symptoms and medical history. An examination of the neck, arms, wrists, and hands will be done. The physical exam will include tests of strength, sensation, and signs of nerve irritation or damage. The exam also may include:

• Phalen Maneuver—Wrists will be held fully flexed, usually one against the other, for about 60 seconds. The test is positive if it produces tingling and numbness in the hand. 
• Tinel's Sign—The doctor will tap firmly on the wrist right over the carpal tunnel to see if it sends an electric shock feeling into the hand.
• Compression Test—Pressure is applied over the wrist for a minute or two to see if it causes tingling and numbness in the hand.
• Other tests may include:
  • Nerve Conduction Study—How quickly the nerves carry signals can be determined by stimulating them with tiny electrodes attached to special machines. This test will show if conduction is slowed through the carpal tunnel.
• Electromyogram (EMG)—Similarly, tiny currents can stimulate muscles. The muscles respond with electrical activity that can be measured. When the nerves connecting to muscles are damaged, the muscles give off abnormal signals.
• X-rays, CT scan, and MRI scan—These imaging tests may identify other causes of carpal tunnel syndrome and can give more detailed information about specific problems.
• Ultrasound—An ultrasound uses sound waves to measure the diameter of the median nerve. It may be used as a screening test or to guide injections.
• Arthroscopy—This minor surgical procedure is useful in both diagnosing and treating CTS. A thin, lighted tube is inserted into the wrist. The surgeon can then look through the tube to see exactly what is wrong.

Treatment

The treatment and management of CTS requires that pressure in the carpal tunnel be reduced. Aside from surgery, medication and lifestyle changes, several other treatments can help ease the symptoms of carpal tunnel syndrome. As with all health problems, the safest and simplest treatments are tried first. If Carpal Tunnel Syndrome is due to another treatable condition, that condition may be treated first to see if the problem resolves. To treat CTS directly, the options are:

• Rest and exercises
• Splinting the affected hand, especially at night
• Non-steroidal, anti-inflammatory medications, like ibuprofen or naproxen
• Cortisone injections
• Surgery

How to Reduce Your Risk of Developing CTS

You may reduce your chances of getting carpal tunnel syndrome by taking these steps:

• Minimize repetitive hand movements when possible.
• Alternate between activities or tasks to reduce the strain on your wrist.
• When using your wrists, keep them straight and let your arms and shoulders share the stress.
• Use your whole hand or both hands to pick up an item.
• Avoid holding an object the same way for a long time.
• Adjust your desk, chair, and keyboard so you are in the best possible ergonomic position:
  • Back straight
  • Feet flat on the floor or resting on a footrest
  • Knees level with or slightly lower than your hips
  • Shoulders in a neutral position, not forward or back
  • Elbows bent at a 90 degree angle
  • Forearms parallel to the floor and wrists straight
• Take breaks at least once an hour to:
  • Rest or shake your hands.
  • Massage the palms and backs of your hands.
  • Do a few stretches and loosening movements of the shoulders and arms before settling in to work. Do them often during the day.
• Keep hands warm, with gloves if necessary.
• Get regular aerobic exercise such as walking or swimming.
• Cut down on caffeine and smoking, which may reduce blood flow to your hands.
• Sleep with your wrists cocked upward instead of bent downward to minimize pressure in the carpal tunnel.

According to a report published by the American Academy of Orthopaedic Surgeons, a simple warm-up routine may greatly reduce the incidence of carpal tunnel syndrome. The warm-up routine is as follows:

1. Hold your hands in front of you as if pushing on a wall. Count to 5.
2. Relax your wrists and fingers.
3. Make tight fists with both hands.
4. Bend both fists downward. Count to 5.
5. Repeat each step 10 times.
6. Then shake arms loosely while hanging at your side.

Contact Dr. Micah Jones to get more information on the prevention, diagnosis, and treatment of Carpal Tunnel Syndrome. You can schedule an appointment by calling the office at (540) 772-3530 or book an appointment online below.