Carpal tunnel syndrom statistics

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

People often omit the “e” at the end of “syndrome” when they’re looking for carpal tunnel syndrome.

Here’s some information that will help you.

From the National Institutes of Health…

Carpal tunnel syndrome is a painful progressive condition caused by compression of a key nerve in the wrist.

It occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. Symptoms usually start gradually, with pain, weakness, or numbness in the hand and wrist, radiating up the arm. As symptoms worsen, people might feel tingling during the day, and decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In some cases no direct cause of the syndrome can be identified. Most likely the disorder is due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others. However, the risk of developing carpal tunnel syndrome is especially common in those performing assembly line work.

Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. Non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease pain. Cold (ice) packs and prednisone (taken by mouth) or lidocaine (injected directly into the wrist) can relieve swelling and pressure on the median nerve and provide immediate, temporary relief. Stretching and strengthening exercises can be helpful in people whose symptoms have abated. If symptoms last for 6 months or more, doctors may recommend surgery to sever the band of tissue around the wrist and reduce pressure on the median nerve.

Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely. To prevent workplace-related carpal tunnel syndrome, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible.

Some people advocate the use of weight training for treatment of carpal tunnel problems.Activities that require additional stress to the flexor muscles will cause them to become even stronger and more hypertonic (rigid), therefore increasing the muscle imbalance between the flexors and extensors. Sometimes these devices can offer short-term relief due to increased circulation, but long-term use often leads to more pain and discomfort due to increased damage to structures within the carpal tunnel.

The strength imbalance between the flexor and extensor muscles will remain the same because both muscle groups are being exercised simultaneously. (Reverse wrist curls are directed at strengthening the extensor muscles, but you still have to contract the flexor muscles in order to grip/hold the weight.) The outcome is still a strength imbalance and the painful symptoms remain. Dual contraction of the flexor and extensor muscles can actually increase the compression of the carpal tunnel and the structures within. This compression decreases the space within the carpal tunnel, causing friction, inflammation and damage to the flexor tendons and median nerve as the wrist/hand is flexed and extended throughout the exercises.

Resistance bands are also used occasionally.These bands only provide partial range of motion, only 1-3 joints used (depending on finger position), instead of 6 joints. Rubber bands do not allow the fingers to move throughout the full range of motion in either flexion or extension, abduction, or wrist and elbow extension. The combination of all of these motions being performed at once is critical for correcting carpal tunnel syndrome, because they stretch the strong, tight, overused flexor and adductor muscles of the hand, while strengthening the weaker, underused extensor and abductor muscles.

The use of splints may be helpful. However, they should be worn primarily at night.Wrist braces and splints hold the wrist in the neutral position instead of the extensor muscles which should be doing it), in order to keep the wrist from moving into forced flexion and impinging the carpal tunnel even more. Using a brace to keep the wrist from dropping into flexion causes the already weak extensor muscles to become even weaker because you do not even have to utilize these muscles to keep the wrist from moving downward into flexion. Using these devices may provide some people with temporary relief for the first few weeks, but long-term use of splints and wrist braces increases the strength imbalance between the flexor and extensor muscles, possibly causing severe damage to the tendons, blood vessels and median nerve within the carpal tunnel.

Using wrist braces and splints at night keeps people from making a "fist" with the wrist in a flexed forward position for 6-8 hours. Holding the wrist in the straight/neutral position is extremely important in order to prevent the flexor muscles from tightening down in a shortened position and impinging the structures within the carpal tunnel.

One published study showed a high failure rate of splinting and non-steroidal drugs.

Failure rate is 81.6% (Including "partial success") in total alleviation of symptoms. Curative rate following treatment is 18.4%.Source: Kaplan, et al, 1990. J Hand Surgery.

Another study looked at iontopheresis and splinting.Failure rate is 42.1% in total alleviation from symptoms. Source: Banta, et al, 1994. J Hand Surgery.

Steroid injection has been shown to help as much as surgery in a few studies. Another study published in t he hand surgery literature was a negative one.

Failure rate is 72.6% after 1-year follow up. ( Including "partial success" as failure) Source: Irwin, et al. J Hand Surgery.

Surgery is no panacea.

When surgery is performed, the carpal ligament is severed in order to increase the space within the carpal tunnel, but since ligaments do not contract, it could not possibly cause the carpal tunnel to narrow. It is a combination of the finger adductor muscles and the wrist and finger flexor muscles that cause the carpal tunnel to narrow and impinge the median nerve. Patients who have had carpal tunnel surgery oftentimes develop the same symptoms again because they develop scar tissue within the carpal tunnel due to improper rehabilitation, and the fact that the real disorder was never addressed. Also, patients will always have a weak grip strength because the carpal ligament has been removed, and it acts as a fulcrum point in which the flexor muscles push against for leverage in order to grasp an object or make a fist.

Carpal tunnel surgery has about a 57% failure rate following patients from 1-day to 6-years. At least one of the following symptoms re-occurred during this time: Pain, Numbness, Tingling sensations. Source: Nancollas, et al, 1995. J Hand Surgery.

Only 23% of all Carpal tunnel syndrome patients were able to return to their previous professions following surgery.

Carpal tunnel syndrome results in the highest number of days lost among all work related injuries. Almost half of the carpal tunnel cases result in 31 days or more of work loss. National Center for Health Statistics .

Surgery for carpal tunnel syndrome is the second most common type of surgery.

Approximately 260,000 carpal tunnel release operations are performed each year, with 47% of the cases considered to be work related. (National Center for Health Statistics.)

Carpal tunnel surgery per se may be a thing of the past. Here's why...A much newer and much less invasive technique that has excellent results is percutaneous ultrasound guided release. In this technique, a small needle is inserted using local anesthetic. Using ultrasound guidance, multiple small holes are made in the flexor retinaculum (the tough fibrous roof over the carpal tunnel that compresses the median nerve). At the same time, fluid is injected into the retinaculum to spread and weaken the fibers. At the end of the procedure, the wrist is flexed (bent) and the weakened retinaculum is released. A splint is applied and the patient has full use of their hand by the next day.

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