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Carpal Tunnel Syndrome

If you've been bothered lately by an ache in your hand or wrist, or if you have numbness in your fingers, you may be feeling the effects of carpal tunnel syndrome.  Carpal tunnel syndrome (CTS) affects millions of Americans, particularly those who use the same hand or wrist motions repeatedly in their work or other activities.  Carpal tunnel syndrome can be painful and, in some cases, disabling.  The good news is, the disorder is preventable and treatable, especially if the right steps are taken early.

Your wrists are among your body's hardest working joints.  They help you perform most of your daily tasks.  Located in the center of your wrist is a narrow passageway about 1½" long, called the carpal tunnel.  Within this narrow opening a major nerve (the median nerve) and several flexor tendons fit snugly together as they pass from the forearm into the hand.  Much of the movement and sensation you enjoy with your hands is made possible by these tendons and the median nerve.

  • The wrist (carpal) bones form the bottom and two sides of the carpal tunnel.
  • The top of the tunnel is formed by the transverse carpal ligament, a tough band of tissue which lies across the heel
  • of the wrist.  It connects the wrist bones and helps stabilize the wrist joint.

  • The median nerve carries sensations from the thumb, the first two fingers and half of the ring finger, to the brain.
  • Nine flexor tendons connect muscles to bone, allowing you to bend the fingers and grasp objects.  They are covered with
  • a lubricating tissue which lets them move smoothly as the fingers or wrist bend and extend.

Wrist1.jpg (62634 bytes)

Cross Section View Showing Anatomy of the Wrist and the Carpal Tunnel

Carpal tunnel problems are typically caused when heavy demands are placed on the hand or wrist through repeated, forceful movements.  Over time, repeated motions lead to wear and tear and swelling of the tendons.  As the tendons swell, they press against the median nerve, squeezing it between the wrist bones and the transverse carpal ligament.   The nerve responds to this excess pressure by sending pain and other sensory signals to the brain.

A wide variety of conditions can cause swelling in the wrist, or make wrist structures take up extra space.  Any of these conditions can result in pressure on the median nerve and related CTS symptoms:

  • Wear and tear (repeated motion causing swelling resulting in increased nerve pressure)
  • Wrist fractures or injuries (narrowing the tunnel as the bones change position)
  • Fluid retention (hormone changes at menopause or pregnancy, obesity, birth control pills, increased salt intake)
  • Other underlying medical conditions (diabetes, rheumatoid arthritis, thyroid imbalance)

Carpal tunnel symptoms usually develop gradually and vary from person to person.   Generally, patients feel pain, numbness, burning or tingling (like "pins and needles") in the hand, wrist, or fingers (especially the thumb, index, and middle fingers).  Pain may radiate up the arm to the elbow, neck or shoulder.  Symptoms can be constant or come and go.  They often get worse at night or after strenuous activity involving the hands.  One or both hands may be affected.

Without treatment, CTS symptoms may continue to get worse.  You may have increased pain, decreased feeling in the hand, and gradual loss of grip strength.  Simple tasks like grasping a handle or utensil may prove difficult.  If you're experiencing CTS symptoms, getting help early can bring prompt relief while reducing the risk of permanent nerve damage.

A variety of treatments is available to help relieve or eliminate carpal tunnel symptoms.  Each is designed to reduce swelling and pressure on the median nerve.   Non-surgical treatments may be al that's needed to control your symptoms.  But if it continues, or the threat of nerve damage exists, effective surgical treatment is available.

  • Wrist Splints.  Since flexing the wrist can worsen symptoms, a rigid splint device may be used to keep the wrist
  • straight and restrict movement.  Splints may be worn at night, during the day, or both.

  • Medications.  To reduce the symptoms of pain, swelling or fluid retention.
  • Cortisone Injections.  To reduce inflammation within the wrist.
  • Surgical Treatment.   The transverse ligament is surgically cut to "release" the carpal tunnel and relieve nerve
  • pressure.  The procedure is performed as outpatient surgery (usually under local anesthesia) and normally takes 30 - 60 minutes.

 

This news letter does not replace professional medical care.
See your physician for diagnosis and treatment of medical problems.
Reprinted with permission of Evergreen Publications.

 

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