Get a Grip
Relieving The Pain Of Carpal Tunnel Syndrome
By Anthony Brentlinger, M.D.
The carpal tunnel is a narrow, rigid passageway of ligaments and bones at the wrist through which eight flexor tendons and the median nerve pass. Carpal tunnel syndrome (CTS) develops when the median nerve, which runs from the forearm into the hand, is compressed within this tunnel. The median nerve transmits sensory impulses from the thumb, index, middle, and ring finger and also innervates the small muscles in the thumb that coordinate its movements.
Pain, weakness, or numbness of the hand and fingers is known all too well to those who suffer from this expression of hand dysfunction. Repetitive activities ranging from keyboarding to band sawing are often implicated, but most cases of CTS have no known underlying cause.
CTS is extremely common. I would estimate there are close to 5,000 new patients per year, clinicwide. Moreover, women are more likely to present with CTS than are men. The general age range for individuals with CTS is 40 to 60 years.
Signs and Symptoms
CTS symptoms stem from the pressure on the median nerve at the base of the hand. This increased pressure can result from swelling around the tendons, inflammation, or injury.
Some of the most common CTS symptoms include burning, tingling, or numbness in the palm and fingers, particularly the thumb, index, and middle fingers. Many patients complain that their fingers feel swollen with no apparent swelling. The desire to “shake out” discomfort in hand or wrist, especially in the early morning, is another common symptom, as is a decrease in grip strength with difficulty grasping small objects.
Many people can tolerate some tendon irritation. It is simply a fact of having an active lifestyle and using muscles and bones. Yet, in some individuals, the housing, or tunnel, is more susceptible to swelling than in others. And for these people, it does not take much swelling in the carpal tunnel for the space to fill and pinch the median nerve.
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What Causes CTS?
It is not only repeated activity that can cause CTS. A wrist injury or mechanical problems can do the same. Even fluid retention related to pregnancy or certain medical conditions can cause CTS.
CTS is often the result of a combination of factors that increase the pressure on the median nerve within the carpal tunnel. Other contributing factors include: hypothyroidism, rheumatoid arthritis, work-related repetitive use, repeated use of vibrating hand tools, or the development of a cyst or tumor in the carpal tunnel. Though in many cases, no specific cause is identifiable.
CTS Relief
The goal of treating CTS is to return normal function, reduce inflammation of tissues in the wrist that puts pressure on the median nerve, and determine the causes of the CTS symptoms. You can then identify which activities to avoid and ways to prevent the condition, nerve damage, and loss of muscle strength in your fingers and hand.
CTS treatment is based on the seriousness of the condition - whether there is any nerve damage and whether other treatment has helped. Treatment options include conservative and surgical methods.
The earlier CTS is diagnosed and treated, the better the results. Splinting to avoid bending the wrist is a good way to alleviate CTS pain. The best results are often obtained by splinting in combination with anti-inflammatory medication or a corticosteroid injection.
Injections can often improve CTS symptoms by reducing swelling or inflammation around the nerve, thereby reducing compression. It is possibly curative in early, mild cases and is often temporarily beneficial in more severe cases.