Carpal tunnel syndrome (CTS) is a condition in which the median nerve that runs through your palm, wrist, and bottom of your hand becomes compressed or irritated – leading to pain, numbness, and tingling in your fingers and hand. A ligament in the wrist often thickens causing extra pressure on the median nerve in the wrist. As the ligament gets thicker, they can become put extra pressure on the nerve, causing some nerves to stop working properly.
Carpal Tunnel Syndrome Medical Definition
Carpal tunnel syndrome, also called median nerve compression syndrome, occurs when one of the major nerves of the upper extremity gets squeezed in the wrist.
The carpal tunnel is a narrow canal or tunnel in the wrist. It’s located just below the base of the thumb and above the wrist bone. The median nerve travels through this tunnel to leave the forearm and enter the hand. When you bend your wrist forward, the tendons on the backside of your wrist pull against the bones at the end of your arm, creating tension. This causes increased pressure on the median nerve.
The tunnel consists of carpal bones, ligaments, the median nerve, and tendons.
Carpal bones: These bones are found on both sides of the tunnel. They protect the tendons and ligaments that connect the forearm bones to the hand.
Ligament: A thick band of tissue that holds the tunnel together. Specifically the transverse carpal ligament is involved in carpal tunnel syndrome.
Median nerve: The median nerve is a sensory and motor nerve that provides feeling and motion to the thumb, index finger, middle finger, and half of the ring finger. The median nerve adds strength to the thumb’s base and index finger.
Tendons: Tendons are strong bands of fibrous tissue that attach muscle to bone. They facilitate the bending of fingers and thumbs.
Carpal Tunnel Syndrome in History
Sir James Paget made the first report of median nerve compression on the wrist in 1854. A few decades later in 1913, Pierre Marie and Charles Foix observed the association between carpal ligament pathology and median nerve compression. In 1916, Moersch proposed the name carpal tunnel syndrome. The condition is named after an area in the wrist known as the carpal tunnel.
The first surgery to release the carpal tunnel was performed in the 1930s. Orthopedic surgeons have been well aware of this condition for more than 100 years.
Carpal Tunnel Syndrome Causes
Over time, repeated stress on the tendons and muscles can lead to inflammation around the tendons, which results in swelling (tendonitis) and scarring. Scarring around the tendons may tighten them up so much that it leads to chronic irritation (tenosynovitis).
Carpal tunnel syndrome can be caused by many things, including repetitive work with your hands, arthritis, pregnancy, obesity, diabetes, thyroid problems, lupus, polio, and more.
Most of the time, it is challenging to determine the exact cause of CTS. A combination of risk factors may be behind the condition.
Carpal Tunnel Diagnosis Techniques
There are several ways to diagnose carpal tunnel syndrome. Doctors diagnose CTS by reviewing your medical history and performing a physical examination, nerve conduction study (NCS), or electromyography (EMG).
During the physical examination, you’ll be asked about any symptoms you’ve had in your hands. You might notice pain, weakness, tingling, burning, or other sensations. Your doctor will then examine your wrists and hands. They will look at your skin and check for signs of a hand injury. Your doctor will also test the feeling in the fingers and thumb. They will ask questions about your job and activities to get a better idea of how much and in what way you regularly use your wrists and hands.
Carpal tunnel syndrome diagnosed with NCSinvolves using electrodes to measure how fast the electrical impulses travel along the nerve fibers. Nerve conduction studies help identify whether there is damage to the nerve itself.
Electromyography uses tiny sensors to record electrical activity from muscles. It helps determine if there is a problem with the nerve, muscle, or tendon. Both techniques can be used to determine whether there is any damage to the muscles and nerves.
Some providers may also recommend an X-ray and Ultrasound Imaging of the affected wrist joint. X-rays can rule out other causes of wrist pain, such as arthritis or fractures. An ultrasound can detect swelling in the soft tissue around the wrist.
Who Gets Carpal Tunnel Syndrome?
It is estimated that 3–6% of the general population suffers from carpal tunnel syndrome. Adults are generally affected by carpal tunnel syndrome; CTS most commonly occurs between the ages of 30 and 60. According to the National Institute of Neurological Disorders and Stroke, women have a three-fold higher risk of developing carpal tunnel syndrome than men, likely because their wrists are smaller.
Workplace factors may exacerbate existing pressure on the median nerve. People working in certain occupations may be more likely to develop carpal tunnel syndrome. That includes manufacturing, assembly lines, lumberjack’s, , meatpacking, and jobs with vibratory tools.
A person with diabetes or other metabolic disorders that directly affect the nervous system is more likely to experience compression. A sedentary lifestyle, a high BMI, salt intake, and smoking are some lifestyle factors that can also increase the risk of CTS.
Carpal Tunnel Syndrome and Daily Life
While carpal tunnel syndrome is a common condition, it does not usually cause serious problems. However, it can lead to significant disability. It is essential to treat CTS early because it can worsen over time.
Carpal Tunnel Syndrome Symptoms
As a result of the median nerve compression, symptoms usually appear along the nerve path. It is common to drop objects due to hand fatigue. Other symptoms of carpal tunnel may include:
- Pain, numbness, or tingling in the hand, arm, or shoulder
- Weakness in the hand, finger, or thumb
- Tenderness in the palm
- Swelling of the hand
- Burning sensation when sleeping
Carpal Tunnel Challenges in The Workplace
According to the Rheumatology Research Foundation, carpal tunnel syndrome affects between four and ten million Americans each year, making it difficult to work efficiently or perform daily tasks.
Carpal tunnel syndrome occurs commonly in working-age adults due to the repetitive, forceful wrist and hand movements or use of hand-held vibrating tools. In addition, certain jobs require prolonged use of the hands and wrists, which increases the likelihood of developing CTS.
At work, primary control measures can help prevent or lessen symptoms associated with carpal tunnel syndrome.
Aids to Help with Carpal Tunnel Syndrome
Carpal tunnel syndrome typically starts slowly and develops gradually. Over time, however, it can become very painful. For this reason, it is crucial to seek medical attention if you notice any changes in your hand function.
Here are some remedies for carpal tunnel relief:
Reduce repetitive motions: Whether you’re building, operating machinery, or performing another repetitive task, try to reduce the number of hours you spend doing so. If you are unable to reduce the amount, take frequent breaks from the activity. When you stop what you’re doing, lower your arms until they’re perpendicular to the floor. This will allow blood to flow back into your hands and relieve the stress on your nerves.
Wear wrist braces: Wrist braces have been shown to provide temporary relief for carpal tunnel syndrome. They can be worn when you need to keep your hands elevated. You can wear them while sleeping as well. Wearing a wrist splint can help prevent symptoms from occurring.
Wrist exercises: Nerve gliding exercises for your wrists can help improve circulation and relieve pain. These exercises should be performed regularly to maintain strength and flexibility. You should avoid activities that cause your wrist to flex more than normal.
Ergonomic changes: You can also make some adjustments to your work environment to reduce the amount of force you are exerting. Redesigning your workstation, adjusting your chair height, and changing the position of your hands and wrists can enhance posture and minimize unnecessary movements.
Physical and occupational therapy: Your doctor may recommend physical therapy to help strengthen weak muscles and improve circulation. They may also suggest occupational therapy to teach you how to perform activities without causing pain.
Medication: Some medications can help ease the discomfort caused by carpal tunnel syndrome. These include anti-inflammatory drugs such as ibuprofen (Advil) and naproxen (Aleve). Additionally, these can reduce inflammation around the nerve and ease any pain you may have.
Carpal Tunnel Syndrome Prognosis and Treatment
The prognosis for carpal tunnel syndrome depends on several factors, including the severity of the condition and whether surgery (carpal tunnel release) is required. While there is a cure for carpal tunnel syndrome, treatment options can help alleviate symptoms.
Carpal tunnel syndrome surgery is usually recommended only when other treatments have failed and when the median nerve has been severely damaged. To treat CTS, your surgeon will cut the band of tissue (transverse carpal ligament) that crosses your median nerve in your wrist to relieve pressure on your nerve. The age of the patient, the duration of symptoms, diabetes mellitus, and the presence of weakness (which is usually a late sign) are factors that determine whether or not the treatment is successful. The outcome is generally positive.
Contact your physician immediately if you experience numbness, tingling, burning, or weakness in your hand or fingers. Early diagnosis and treatment can help limit the effects of carpal tunnel syndrome.
Questions to Ask Your Doctor
If you suspect you have carpal tunnel syndrome, ask your doctor questions about your signs and symptoms. Don’t hesitate to tell them about your feelings and experiences regarding this condition. Before evaluating the problem, you should discuss all potential causes of your symptoms with your doctor. Include in your discussion any new symptoms that occur after an injury.
When visiting your doctor about CTS, ask them the following questions:
- What are some common symptoms of carpal tunnel
- How did I get carpal tunnel syndrome?
- What is the best treatment option?
- Will I need carpal tunnel surgery?
- Are there any alternatives to carpal tunnel syndrome surgery?
- Can my job change affect my chances of recovery?
- How long will it take to recover?
- Is there anything else I can do to treat my carpal tunnel syndrome?
If you think you might have the CTS, see your doctor immediately. Carpal tunnel syndrome treated early can prevent the development of permanent nerve damage. Our doctors at Academy Orthopedics are here to provide expert care for patients who suffer from hand and wrist problems. Contact us today to schedule an appointment.
Carpal Tunnel Syndrome and Health Insurance
Carpal tunnel syndrome is usually covered by private insurance. A study published in the National Library of Medicine shows that people seeking treatment for CTS in the United States are more likely to be covered by private insurance than Medicaid or Worker’s Compensation.
Most health insurance plans cover some costs associated with treating carpal tunnel syndrome. If your plan does not, contact your health care provider to find out what expenses are covered and which ones are not. As always, check with your own insurance company first.
Is Surgery Right for You?
If you have severe pain, loss of function, and/or weakness in your arm or hand, your doctor may recommend surgical intervention as the primary treatment. However, many patients with milder cases of CTS respond well to nonsurgical interventions such as splinting, cortisone injections into the affected area, and physical therapy.
In general, nonsurgical management is considered appropriate for patients whose symptoms meet one or more of the following criteria:
- Pand and numbness caused by nerve compression that is relieved by rest.
- Symptoms improve within three months.
- There is no evidence of nerve damage.
- The symptoms come from another cause.
Your doctor will consider these factors along with your overall health status when determining whether surgery is necessary. In addition, keep in mind that nonsurgical treatments are usually less expensive and require fewer office visits.
Your surgeon will evaluate your risk factors for developing recurrent carpal tunnel syndrome and may suggest changes in your lifestyle to reduce your risk of recurrence. These factors include your age; gender; obesity; diabetes; cigarette smoking; other medical conditions, such as rheumatoid arthritis, thyroid disease, high blood pressure, lupus, osteoarthritis, pregnancy, or previous surgeries related to your hands or wrists; history of wrist fractures; family history of neuropathy; use of the vibrating tools that can cause CTS; and heavy lifting. Your surgeon may also recommend modifications to your workplace.
If you decide to undergo carpal tunnel surgery, various techniques exist for decompressing the median nerve at the wrist. Surgeons generally prefer an open release procedure that cuts the transverse carpal ligament. This releases the offending structures and allows them to move apart. The operation is called carpal tunnel release surgery.
Although the choice depends on how extensive the release needs to be, you should discuss all available options with your physician before deciding upon a course of action.
Get in Touch with a Carpal Tunnel Specialist!
At Academy Orthopedics, we have found that early diagnosis and good patient education are the most critical factors in having a successful outcome after surgery. Early signs of carpal tunnel syndrome (CTS) should be evaluated promptly because the longer the delay between symptom onset and treatment, the worse the prognosis. Many people who develop this condition do not realize they have it until they experience a significant disruption of their daily life.
If you experience any of the symptoms mentioned above, see our physician soon for a proper evaluation. Book an appointment today!