Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS)is a real problem for many people. Left untreated, CTS can lead to permanent disability or surgery.

In CTS, you may notice your hand or hands getting numb or tingly. Sometimes there's pain shooting up the arm from the wrist, or weakness in the hand. You may start to drop things. Night pain is an especially important and significant symptom. If you wake up at night with numbness in your hand(s) and find yourself shaking your hand to get the feeling back, CTS is likely. You should see your doctor if you get these symptoms.

How does CTS occur? The carpal tunnel is where the median nerve and some of the tendons to your fingers pass through the wrist. This "tunnel" lies just beneath the creases on the middle of the inside of your wrist. In this area, the bones form a U-shape with a band or "strap" of tissue across the top of the "U". This band prevents the tendons from bulging out when you bend your wrist forward and grasp. There's not a lot of extra room here, and if things get tight, there's extra pressure on the nerve.

Try this: straighten out your wrist and fingers so your hand's straight in line with your forearm, as if it were resting flat on a table. Now feel the inside of your wrist where the creases are on the inside of your wrist. Then, bend your hand and wrist back. You'll notice that the inside of your wrist in that area gets harder. This is putting pressure on those structures in the carpal tunnel.

A new injury like a bad sprain, fracture, crush injury, or dislocation can cause acute carpal tunnel syndrome or nerve compression. If you've injured your wrist recently and are wearing a splint, cast, or even an elastic bandage, watch out for numbness or throbbing, especially in the first day or so after injury or casting. If it isn't relieved by loosening the elastic wrap and/or by elevating the injured wrist, get in touch with your doc as soon as possible.

More typically, inflammation and/or swelling of wrist structures cause the first episode. You may only feel pain or tingling, which gets better. This doesn't mean there's no problem: if you repeat the activity that caused the problem originally, it may recur, and it may be worse. Eventually, if pressure on the median nerve continues, you may get frequent tingling, pain, weakness, or numbness.

Activities that stress the tendons in your wrist over and over are a type of repetitive trauma, and are a major cause of carpal tunnel syndrome. When you use muscles or tendons a lot, they tend to get bigger and stronger. That's OK for your bicep, since it's not in a confined space. However, when the tendons in your carpal tunnel get bigger from overuse, they put more pressure on the median nerve, which also is in the carpal tunnel. This pressure causes CTS.

In the past, the typical patient with CTS was a jackhammer operator. He'd be squeezing the handle of a jackhammer all day, and the repetitive vibrations could lead to swelling of the tendons in the carpal tunnel. Now, most CTS patients are folks who do lots of keyboarding or other data entry (like cashiering in a supermarket).

A common test for CTS is tapping an area on the inside of your wrist with a fingertip. If it causes pain or tingling to shoot out into the hand, it's a sign of CTS.

Treatment for carpal tunnel syndrome can take a long time. There are two types of therapy: non-surgical and surgical. Non-surgical treatment includes aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs (also known as NSAIDS) as well as rest, elimination of the precipitating cause, PT, and wrist splints, especially at night. The splints seem to be very helpful in some patients: if you have carpal tunnel syndrome and haven't tried them, you should. Remember, also, that acetaminophen (as in Tylenol) doesn't have anti-inflammatory effects, and isn't as helpful as an NSAID.

Try to be aware of the position of your wrist. If structures in the carpal tunnel are already swollen, having your wrist back will make things worse. Keeping your wrist in a neutral position is one of the big advantages of night splints. It can also remind you not to overstress that wrist.

Surgery for carpal tunnel syndrome is indicated when you've got a hand that's getting worse despite conservative measures like PT, rest, splints, and NSAIDS. If you've got a hand or fingers that are numb most or all of the time, you may be a good candidate for surgery. Surgery might also be needed if you've got an acute buildup of pressure due to a crush injury or a fracture.

Luckily, surgery for CTS is usually very helpful, as long as you haven't delayed so long that the continuing pressure on the nerve has caused permanent damage. In CTS surgery the surgeon will usually lengthen the "strap" that goes over the top of the tunnel. This relieves the pressure, and often cures the symptoms and prevents them from recurring.

(c)flash gordon md 2003


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