Carpal Tunnel Syndrome – You’re not alone
You are riding your motorcycle trying to ignore the tingling and numbness in your hands and wrists followed by sharp pains. Maybe it’s a resulting cramp from the long ride? Maybe it’s something more serious with long-term damages such as the dreaded Carpal Tunnel Syndrome (CST).
Carpal tunnel is a narrow, rigid passageway of ligament and bones at the base of the hand that houses the median nerve and tendons. The median nerve and tendons run from your forearm to the palm of your hand through a small space in your wrist. This painful condition, CTS is caused by pressure to the median nerve. The pressure can come from swelling or anything that makes the carpal tunnel smaller. Certain health problems such as hypothyroidism, rheumatoid arthritis and diabetes can lead to carpal tunnel syndrome. Other factors are age, pregnancy (fluid retention), menopause, obesity, wrist injuries and bone spurs (making the same hand and wrist movements over and over, especially if the wrist is bent down), over-activity of the pituitary gland, work stress, repeated use of vibrating hand tools, smoking or the development of a cyst or tumor in the canal. In most cases, no cause can be identified. CTS can cause burning, tingling, numbness, weakness or pain in the fingers or hand. Pain may also occur in the arm between the hand and the elbow. Although painful sensations may indicate other conditions, CTS is the most common and widely known of the entrapment neuropathies in which the body’s peripheral nerves are compressed or traumatized. CTS appear to be caused by a combination of genetic and environmental factors.
Your first symptom of CTS may be at night in one or both hands. Recent studies suggest that sleeping on one’s side might be an associated factor due to the wrists being held flexed during sleep. Wearing a wrist splint may prevent flexion. Symptoms most often occur in the thumb, index finger, middle finger and half of the ring finger. The median nerve controls sensations to the palm side of the thumb and fingers, except for the little finger. A person with CTS may wake up feeling the need to shake their hand or wrist. Tingling sensations during the day may be felt as the symptoms worsen. Decreased grip strength may make it difficult to form a fist, grasp small objects or perform other manual tasks. If this condition is left untreated, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold touch. CTS usually occur in adults only. Women are three times more likely than men to develop carpal tunnel syndrome between the ages of 45-60 years old with a ratio of 3:1. Caucasians have the highest risk of CTS compared to other races. In the U.S., approximately 1 out of 20 people will suffer from CTS with only 10% of reported cases being younger than 30 years old.
The warning signs that our bodies generate are key to early detection of any ailment, disease or syndrome. To avoid permanent damage to the median nerve, early diagnosis and treatment is important. Under a doctor’s care, a physical examination of the hands, arms, shoulders and neck can help to determine if the patient’s complaints are related to daily activities or to an underlying disorder and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth and discoloration. Each finger is tested for sensation, and the muscles at the base of the hand are examined for strength and signs of atrophy. Routine laboratory tests and X-rays can also be done.
Various drugs can ease the pain and swelling associated with CTS such as: aspirin, ibuprofen, other non-prescription pain relievers, diuretics (water pills to decrease swelling) and corticosteroids (such as prednisone). Applying cool packs can also help reduce swelling. Supervised by a physical therapist, stretching and strengthening exercises can be helpful for people whose symptoms have abated. Although alternative therapies remain unproved, acupuncture and chiropractic care have benefited some patients. Yoga, an exception to the rule, has been shown to reduce pain and improve grip strength among patients with CTS.
Surgery is an option. One of the most common surgical procedures in the United States is carpal tunnel release (open release surgery). This procedure is generally recommended if symptoms last for 6-months. Performed under local anesthesia and on an outpatient basis, the surgery consists of making a 2 inch incision in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. Another procedure is endoscopic surgery which is generally effective and minimizes scarring and scar tenderness. Performed under local anesthesia and on an outpatient basis, this two-portal surgery consists of two ½ inch each incisions in the wrist and palm. The surgeon inserts a camera attached to a tube, observes the tissue on the screen and cuts the carpal ligament. After either surgery, symptoms may be relieved immediately. However, full recovery from carpal tunnel surgery can take months. During this time, some patients may experience the following: infection, nerve damage, stiffness, pain at the scar and loss of strength in the wrist. Physical therapy is recommended after surgery to restore wrist strength. Patients may even need to adjust job duties or change jobs after recovery from surgery. The majority of patients recover completely and recurrence of CTS after successful surgery is rare. However, if a person is experiencing hand pain after surgery, most likely they were diagnosed incorrectly. Studies suggest that in some cases, surgery does not completely get rid of the numbness or pain. I guess it really depends on who you ask.
To keep CTS from coming back, the following basic health care is recommended:
- Maintain a healthy weight
- Don’t smoke
- Exercise to stay strong and flexible
- Keep wrists in a neutral position
- Switch hands often when repeating movements
For additional information on CTS, please visit: emedicinehealth.com
Peace and Blessings,