Carpal Tunnel Syndrome is a painful condition that can have a disabling effect on the wrist, hand, and fingers. CTS results from an abnormal amount of pressure being placed on a median nerve in the wrist. The increased pressure can be related to a decrease in size of the carpal tunnel itself (tunnel on the palm side of the wrist-hand) or an inflammatory process in one of the structures (usually flexor tendon sheaths) that passes through it. Pressure on the median nerve can result in pain, numbness, tingling, and weakness in the hands, and fingers (usually the thumb, index, and middle fingers). There may also be decreased joint mobility in the wrist, and fingers. Pain may radiate up the arm to the shoulder and possibly the neck. If left untreated, it can result in permanent nerve damage.

Risk factors of CTS

• Females
• Age 40 or older
• Job or hobbies involving repetitive tasks
• Rheumatoid or osteoarthritis of the wrist
• Hypothyroidism
• Pregnancy
• Trauma to wrist
• Menopause
• Obesity
• Diabetes

The symptoms are commonly associated with repetitive movements of the wrist and hand. Occupations with a high risk of developing CTS include typists, hairdressers, gardeners, dentists, factory workers, truck drivers, knitters, needle pointers and painters. Wear and tear to the wrist causes a thickening of the sheath of the flexor tendons, which can cause undue pressing on the nerve. Other causes include direct trauma, wrist fracture or dislocation, resulting in localized swelling and narrowing of the carpal tunnel. CTS may also be caused by arthritis, diabetes and fluid retention, especially during pregnancy.

Symptoms of CTS

• Numbness and tingling -"pins and needles in the hand"
• Night Pain - May occur several times a night
• Daytime pain - aggravated by activity
• Thumb weakness - grasping difficulties

CTS is manageable when detected early. It is important to see a physician, especially an orthopedic doctor, to get a correct medical diagnosis.

Early treatment of CTS includes bracing, activity modification, rest, ice and medication. A brace can be worn during activities to stabilize the wrist. A splint can also be worn at night when pain or numbness commonly interrupts sleep. Activities that provoke symptoms should be modified. For example, adjusting the computer keyboard height and rotating repetitive job activities. A cortisone injection into the carpal tunnel may also relieve the inflammation.

In the sub-acute stage, an emphasis is placed on stretching the wrist, fingers and the transverse carpal ligament. Again, wrist positioning is important and the patient should avoid such activities that reproduce their symptoms.

In the chronic stage, strengthening exercises of the entire extremity including the upper back and shoulders are recommended to regain lost strength due to immobilization and inactivity. Good spinal posture is important as the upper back and shoulders are the platform for the wrist and hand.

If conservative measures are ineffective, the doctor may opt for surgical treatment. A small incision is made in the lower palm to expose the transverse carpal ligament, (TCL) which is then released. By cutting the TCL, the space within the carpal tunnel is increased thus releasing the pressure on the nerve. On occasion removal of swollen tendon sheaths (Teno Synovitis) is an important adjunct to the release segment of the surgery.

Tips to avoid Carpal Tunnel Syndrome

• Keep wrist in neutral position during activity
• Decrease repetitive motions
• Use dynamic bracing during activity
• Watch your grip - use as much of the hand and as many fingers as possible
• Reduce speed and force of repetitive activity
• Rest and use alternate hands - take breaks during prolonged activities
• Stretch hands and wrists throughout day
• Use cold packs on wrist after prolonged activity to decrease inflammation (Be careful to avoid frost bite)

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