Carpal tunnel syndrome (CTS) occurs when the median nerve, one of the nerves in the hand, is compressed. CTS affects approximately 50 out of 1,000 people.
The median nerve starts at the base of the neck, travels down the arm, and through the wrist into the hand. The median nerve provides feeling and allows for movement of the thumb, index, middle, and ring fingers in our hands. Just before entering the hand, the median nerve passes through a narrow passageway, which resembles a small tunnel, in the wrist, also known as the carpal tunnel. This passageway is made up of bones, tendons, and ligaments. Anything that can irritate, squeeze, or compress the median nerve can lead to the development of CTS.
Symptoms of CTS include:
- Tingling, numbness, and burning senstions in the affected hand(s)
- Shooting pain
- Pain worsened by certain hand positions or movements, such as holding a phone or steering wheel
- Pain when waking up in the morning
- Weakness in the affected hand(s)
Symptoms of pain can be intermittent, prolonged, or even constant. CTS may also cause reduced range of motion, weakness, and a tendency to drop things.
Although many cases of CTS develop without a specific cause, the following factors may increase the risk of developing CTS:
- Age: The onset of CTS is highest in those who are 40–60 years of age.
- Gender: Females are 3 to 10 times more likely than males to develop CTS, which may be because females, on average, have smaller wrists than males.
- Injuries: Most common injuries leading to development of CTS include fractures, dislocations, severe bruising, and burns of the wrist or lower forearm.
- Chronic health conditions:
- Inflammatory conditions, such as rheumatoid arthritis and diabetes, may cause inflammation that can irritate the median nerve.
- Some health conditions may increase fluid volume within the wrist, leading to compression of the median nerve. Examples include pregnancy, menopause, use of oral contraceptives, obesity, heart failure, kidney failure, and hypothyroidism.
- Repetitive motion: Jobs, hobbies, and sports that require repetitive hand movement may contribute to irritation of the median nerve. Examples include assembly line workers, cashiers, hair stylists, massage therapists, construction workers, bakers, musicians, knitters, gardeners, and golfers.
Evaluation and Testing
If you have symptoms of CTS, contact your healthcare provider. Other conditions with similar symptoms, including multiple sclerosis (MS), osteoarthritis, rheumatoid arthritis, tendonitis, and nerve tumors, may mimic CTS. Your healthcare provider will be able to determine your diagnosis after a complete evaluation. During the evaluation, your healthcare provider may perform non-invasive testing including the Tinel’s sign test and Phalen’s sign test. Your healthcare provider may order further testing or give you a referral to a specialist if necessary.
Treatment by your healthcare provider depends on the severity of symptoms, mechanism of injury, and possible underlying conditions. Recommendations to relieve symptoms frequently include:
- Minimizing or avoiding aggravating movements and activities; making ergonomic changes at work
- Warm up, stretching, and loosening exercises for hand and wrist
- Heat therapy
- Use of a wrist brace
- Analgesic and anti-inflammatory medication
Occupational therapy can also provide a comprehensive treatment program. In some cases, more invasive treatment options, such as steroid injections or surgery, may be necessary. It is important that you follow your healthcare provider’s recommendations and treatment options for you.
Prevention of CTS can be as simple as minimizing or avoiding repetitive and sustained strain of your hands and wrists. However, for those who have risk factors, prevention of CTS should be more structured.
If you are performing repetitive motion tasks, you should take scheduled breaks from repetitive activities. Even short scheduled breaks can provide a therapeutic relief of tension in the wrists and prevent unwanted strain. These breaks can be even more beneficial when coupled with stretching exercises.
Wrist strengthening exercises can help build strength in the small muscles, tendons, and ligaments which can help provide more stability, strength, and flexibility. Strengthening exercises can improve resistance to periods of prolonged and repetitive tension of the extremities.
Massage, heat application, and warm water or paraffin baths may provide tension relief and deep relaxation of the carpal tunnel structures, hands, and wrists.
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