Carpal Tunnel Syndrome

Derived from the Greek word “karpos”, meaning wrist, Carpal Tunnel Syndrome occurs when the median nerve becomes compressed at the wrist.  The median nerve which runs from the forearm into the hand controls the sensation of the thumb and fingers.  The carpal tunnel, which is a narrow, rigid passageway of ligaments and bones at the base of the hand, houses the median nerve and tendons.  The thickening of the tendons or the swelling of the carpal tunnel compresses the median nerve, resulting to pain, weakness or numbness of the hand and wrist.  Although pain may be an indication of other conditions, carpal tunnel syndrome is widely known for the entrapment of neuropathies in which the body’s peripheral nerves are compressed and traumatized. 

Causes

Carpal tunnel syndrome is often the result of several factors that add pressure on the median nerve and tendons in the carpal tunnel.  It may be due to a congenital predisposition since the carpal tunnel of some people is smaller than others.  Other contributing factors include trauma or injury to the wrist that causes swelling such as sprains or fractures; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; fluid retention during pregnancy or menopause; or development of cyst or tumor in the canal. 

Risk factors

A person’s gender, health condition and nature of work are risk factors to watch out for.  According to studies, women are 3 times more likely than men to develop carpal tunnel syndrome, perhaps because women generally have smaller carpal tunnels than men.  The dominant hand is usually the first to get affected and experience severe pain.

People with metabolic disorders like diabetes are highly susceptible to median nerve compression.  The risk increases even more as they age. 

The risk of developing carpal tunnel syndrome is not confined to people in a single industry, but it is more common among those whose job requires wrist movements such as sewing, fishing and cleaning.  Consequently, office workers with intensive typing work are susceptible to carpal tunnel syndrome. 

Diagnosis

Early diagnosis and treatment are important to avoid permanent damage to the median nerve.  A physical examination of the hands, arms, shoulders and neck can help determine if the patient’s complaints are due to daily activities or an underlying disorder.  The wrist is examined for tenderness, swelling, warmth and discoloration.  Each finger should be tested for sensation and the muscles at the base of the hand are tested for strength and signs of atrophy.

Doctors use specific tests to diagnose carpal tunnel syndrome.  In the Tinnel Test, the doctor exerts pressure on the median nerve in the patient’s wrist.  When a patient experiences tingling in the fingers or a shock-like sensation, the test is a positive.  The Electromyogram Test measures the electrical discharges produced in the muscle to determine if there is damage.  The Nerve Conduction Study works by letting a small shock pass through the median nerve to determine if electrical impulse transmission slows down in the carpal tunnel.

Treatments

Carpal Tunnel Syndrome should be treated as early as possible under doctor’s supervision.  Underlying causes such as diabetes or arthritis should be treated first.  Initial treatment involves wrist splinting to avoid activities that may worsen the symptoms and applying cold therapy to reduce the swelling. 

Non-surgical treatments are available to ease the pain and reduce the swelling caused by carpal tunnel syndrome.  Non-steroidal anti-inflammatory drugs help ease the symptom for a short time.  Corticosteroids can be injected directly to the wrist to relieve the pressure on the median nerve and provide immediate but temporary relief. 

Alternative therapies such as acupuncture and chiropractic treatments have benefited some patients but their effectiveness remains to be proven.  Heat therapy is an exception because studies show that it effectively reduces pain by improving the flow of oxygen-rich blood into the area and ease tense muscles.  Now, heat therapy is even better with Far Infrared Rays that offer deeper penetration to utilize the pain relieving benefits of heat.

If Carpal Tunnel Symptoms persist for more than 6 moths, surgery is usually recommended.  It involves severing the band of tissue around to wrist to reduce the pressure on the median nerve.  Surgery is done under local anesthesia and does not require an overnight hospital stay.  It is still possible for a patient to feel residual pain, numbness, stiffness and weakness in the hand and wrist after a surgery.

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Atroshi  I, Gummesson  C, Johnsson  R, Ornstein  E, Ranstam  J, Rosen  I.  Prevalence of carpal tunnel syndrome in a general population.  JAMA.  1999;282:153–8.

Stevens  JC, Witt  JC, Smith  BE, Weaver  AL.  The frequency of carpal tunnel syndrome in computer users at a medical facility.  Neurology.  2001;56:1568–70.