Causes of carpal tunnel syndrom

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.

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You might have omitted the "e" at the end of syndrome during your search, but no matter...Carpal tunnel syndrome is a common condition that occurs when there is too much pressure on the median nerve in the wrist. There is usually aching, numbness or tingling in the thumb, some of the fingers and sometimes part of the hand.

Carpal tunnel syndrome (CTS) is a common affliction affecting about 1 in 100 people. While both men and women can develop it, CTS is most common in women in their fourth to sixth decades.

Often carpal tunnel syndrome is triggered by a person’s occupation or hobby. Most cases of carpal tunnel syndrome can be prevented by stopping or reducing the activity that stresses the hand and the wrist.

The carpal tunnel is a, well... tunnel, on the palm side of the wrist. The bones of the wrist are arranged in a semi-circle, and a tough ligament (the transverse carpal ligament) forms a roof over them, creating the carpal tunnel. Running through the carpal tunnel are the tendons that are used to flex the fingers and wrist, as well as the median nerve.

There is little room for expansion in the tunnel, so any swelling of the tissue in or around the carpal tunnel can exert pressure on the median nerve and cause carpal tunnel syndrome.

Carpal tunnel syndrome may result from the direct pressure on the tunnel. Repeated wrist movements can also be responsible for this. The movements may be related to a person’s work or hobby. People who use vibration causing tools are particularly at risk.

The carpal tunnel may also be compressed by trauma, by disease, such as rheumatoid arthritis, or even by a condition where excess growth hormone is produced. This condition is called acromegaly.

Another cause of carpal tunnel syndrome can be pressure due to fluid retention as a result of kidney failure, an underactive thyroid or pregnancy. It can be caused by changes to the median nerve itself, too, which may happen with conditions such as diabetes.

Carpal tunnel syndrome is more common in people who are obese, in women who are pregnant, or taking the contraceptive pill, and during menopause. In some people, it develops for no obvious reason.

Symptoms include aching, tingling, pins and needles, burning, numbness or pain in the hand and in the fingers innervated by the median nerve – the thumb, the index and middle fingers, and part of the ring finger. Sometimes, symptoms can spread to the arm and shoulder.

These symptoms tend to be worse at night or first thing in the morning and are often aggravated by strenuous wrist movements.

Carpal tunnel syndrome can affect one or both hands, and the severity of the symptoms can vary. The symptoms may be mild in the beginning. As the condition worsens, symptoms may become more constant. The hand muscles become weak, causing loss of grip strength.

Patients may find temporary relief from symptoms by hanging their arm over the side of the bed at night or by shaking their hand vigorously. Mild symptoms may also be relieved by applying ice packs to the wrist and by resting the hands and wrists. Wrist splints can be used. These help to keep the wrist straight and avoid putting more pressure on the compressed nerve.

It is important to try and avoid repetitive motions that worsen the symptoms. Changing the way repetitive movements are done, reducing the frequency of the movements, and increasing the amount of rest between periods of activity may help.

Stretching exercises and massage may be effective for relieving symptoms.

There are other medicines available that may help reduce the symptoms of carpal tunnel syndrome.

•Steroid injections are given into the carpal tunnel to reduce swelling and provide relief from symptoms.
•Prescription NSAIDs may help.
•If excess fluid is thought to be causing the swelling, a diuretic drug may relieve symptoms.
•Vitamin B6 (pyridoxine) may be helpful in some cases.

Some people find that acupuncture helps reduce pain.

If the symptoms get worse, surgery which involves cutting the transverse carpal ligament to make more space for the nerves and tendons in the carpal tunnel, may be needed. The operation may be done using an endoscope, a thin telescope that is inserted into a small cut in the wrist. In a more traditional operation, a longer cut is made in the palm of the hand. The endoscopic repair leaves a smaller scar, and usually allows people to get back to their usual activities more quickly. However, there may be a slightly higher risk of nerve damage with the endoscopic repair.

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.

Some people have symptoms that get worse, while others only have symptoms from time to time. If treated early, mild cases usually get better without surgery.

Improvement may occur once the underlying cause is removed. For example, after the end of a pregnancy, or when any underlying condition, such as diabetes or an underactive thyroid, is treated, CTS symptoms may leave.

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