Carpal Tunnel Syndrome: Causes, Treatment, and More

What is a carpal tunnel?

The carpal tunnel is an osteofibrous canal, a narrow passageway, located in the wrist. Basically, carpal tunnel is a passageway on the palm of your wrist. It is comprised of bones and ligaments. The median nerve which regulates the movement and sensation in the thumb and first three fingers runs through this narrow passageway together with tendons to the thumb and fingers.

Although carpal tunnel is narrow, it contains nine tendons of the forearm musculature which pass through the passageway. The tunnel is bounded by the bones of the wrist as well as a fibrous band on the palmer side of the hand near the wrist called flexor retinaculum.

What is a carpal tunnel syndrome?

Carpal tunnel syndrome is a common condition indicated by pain and discomfort in a person’s hand and arm. This is a painful and progressive condition that has the potential to affect someone’s quality of life and prevent a patient from doing some everyday things they used to do with ease. Due to the fact that carpal tunnel syndrome gets worse over time the early diagnosis is vital for treatment and management of symptoms.

The condition has been identified for over one hundred years. Patients who experienced symptoms of carpal tunnel syndrome were usually diagnosed with acroparesthesia, a condition indicated by burning, tingling, and other unpleasant sensations in extremities. The first description of carpal tunnel syndrome operation was published in 1930’s. The condition has become one of the most frequently diagnosed of all peripheral compression-induced neuropathies since the 1960s.

How common is carpal tunnel syndrome?

You already know that carpal tunnel syndrome is a prevalent condition, but how common is it really? According to the study published by the American Family, Physician carpal tunnel syndrome affects between three and six percent of adults in the United States. The condition usually occurs between the ages of 40 and 65. The prevalence of carpal tunnel syndrome increases with age.

One study evaluated the prevalence of carpal tunnel syndrome in the US and found that 7.8% out of 4321 (industrial workers) had the condition. Proportions were higher among women and older age categories. Additionally, incident carpal tunnel syndrome was observed among 5.8% of 3515 workers who contributed at any time during the study period.

Causes of carpal tunnel syndrome

Carpal tunnel syndrome occurs due to pressure on the median nerve. Anything that irritates or squeezes the median nerve in the carpal tunnel area can cause carpal tunnel syndrome. For example, a wrist fracture can narrow the carpal tunnel and irritate the median nerve, but inflammation and swelling caused by rheumatoid arthritis can do the same.

In some cases, the underlying cause of carpal tunnel syndrome is unknown. A combination of different causes and factors can lead to carpal tunnel syndrome, in most people, it’s unlikely that a single cause would induce symptoms of this condition. An underlying medical condition that causes swelling, inflammation and even obstructed flow is linked to carpal tunnel syndrome.

Some of these conditions include:

• Diabetes
• High blood pressure
• Autoimmune conditions such as rheumatoid arthritis
• Thyroid dysfunction
• Fluid retention

Symptoms of carpal tunnel syndrome

Signs and symptoms of carpal tunnel syndrome do not develop suddenly, they start gradually. They tend to develop along the nerve path due to compression of the median nerve. For instance, you may drop something out of your hand, or it falls asleep frequently. The most common symptoms of carpal tunnel syndrome include the following:

• Numbness or tingling in the thumb, index or middle fingers that comes and goes. Sometimes an affected individual feels a sensation resembling an electric shock in three fingers. The electric sensation may go from the wrist up to the arm while you’re holding a phone, keys, newspapers. Sometimes this electric sensation can wake you up from your sleep. It’s not uncommon for people to shake their hand to chase away the numbness, but over time the sensation may become constant
• Discomfort in the wrist and palm of the affected hand
• Weakness in your hand usually due to numbness

It is important to contact your physician immediately when these symptoms develop. When left untreated carpal tunnel syndrome can worsen, muscles weaken, numbness becomes constant all of which negatively affect your arm and hand movements as well as quality of life.

Who is at risk of carpal tunnel syndrome?

Many patients who regularly use computers can develop carpal tunnel syndrome. Below, you can see the risk factors that are strongly associated with this condition:

• Gender – as mentioned above, women are more likely to develop carpal tunnel syndrome
• Age – persons between the ages of 40 and 65 are at a higher carpal tunnel syndrome risk than the younger population
• Occupation – a growing body of evidence confirms that clear associations have been established between carpal tunnel syndrome and workplace activities involving exposure to hand-transmitted vibration, repeated forceful movements of the hand and wrist. These occupations include manufacturing, construction work, keyboarding occupations, and assembly line
• Computer use – for many years it was believed that computer use as a risk factor for carpal tunnel syndrome was a myth, but science says otherwise. Some studies showed that excessive computer use, particularly mouse usage could be a risk factor for this condition
• Nerve-damaging conditions – having a disease or condition that damages your nerves could also affect median nerve and pave the way to carpal tunnel syndrome
• Obesity – being overweight or obese puts you at a higher risk of carpal tunnel syndrome. Studies show that high BMI is a strong factor for carpal tunnel syndrome incidence in younger patients, but not as much in older population
• Fluid retention – alteration in the balance of body fluids can cause pressure on the median nerve and lead to carpal tunnel syndrome. This is a common occurrence in pregnant and menopausal women. However, carpal tunnel syndrome that develops during pregnancy tends to go away after a woman gives birth
• Pregnancy – besides fluid retention, hormonal changes, and increasing body weight make women struggle with carpal tunnel syndrome during this special time in their lives
• Heredity – believe it or not, the condition may have a genetic component

How is carpal tunnel syndrome diagnosed?

Patients who experience symptoms similar to carpal tunnel syndrome should schedule an appointment to see their doctor and describe them in detail. Diagnosis of carpal tunnel syndrome involves a combination of patient history, physical exam, and various tests.

During the physical exam, the doctor will inspect the hand, wrist, shoulder, and neck of the patient to check for causes of pressure on the median nerve. The doctor examines the wrists for the signs of swelling, tenderness, and other problems. The strength of the muscles and sensation to the fingers are also checked.

In some cases, the doctor may order an x-ray to rule out other causes of pain and numbness. Yet another test the doctor may order is electromyogram which measures tiny electrical discharges produced in the muscles. For the purpose of the test, the doctor needs to insert a needle electrode in specific muscles in order to assess the electrical activity when muscles rest and contract. Electromyogram detect muscle damage and also serves to rule out other conditions.

Nerve conduction study is also used for the diagnostic process of carpal tunnel syndrome. It’s similar to electromyogram but includes two electrodes that are taped to the skin. Then, the small shock passes through the median nerve in order to determine whether electrical pulses slow down in the carpal tunnel.

Treatment options for carpal tunnel syndrome

The treatment of carpal tunnel syndrome depends on the severity of symptoms and extent of the damage to the median nerve. The condition can be treated in a nonsurgical and surgical manner.

Nonsurgical options include:

• Corticosteroids to relieve pain, inflammation, and swelling
• NSAIDs to alleviate pain in the short term
• Wearing a wrist splint that keeps the wrist still while sleeping
• Avoidance of positions that overextend the wrist
• Treatment of an underlying condition that led to carpal tunnel syndrome

Surgery is last resort when other treatment options fail. The primary goal of the surgery is to alleviate pain by cutting the ligament that causes pressure on the median nerve. Surgery can be endoscopic (using a camera), minimally-invasive or open surgery.

Besides adhering to the doctor-recommended treatment, patients may change their daily activity at home to help manage their symptoms. Here are some suggestions:

• Avoid sleeping on your hands
• Make frequent breaks from all activities that require repeated use of hands
• Rotate wrists and stretch palms and fingers frequently
• Consider losing weight
• Practice yoga
• Immerse hand in warm or cold water in order to alleviate discomfort and pain
• Relax your grip, i.e. reduce the force you’re using
• Keep hands warm
• Keep wrists and hands elevated whenever possible
• Use topical menthol or other pain relief producarpal tunnel syndrome

The above-mentioned recommendations can also help persons without carpal tunnel syndrome to reduce the risk of developing this condition.

Outlook

The severity of symptoms varies from one person to another. Some people have mild symptoms. At times the pain from carpal tunnel syndrome will resolve after conservative care and observation. Timely diagnosis and adequate treatment have a high chance of improving a person’s quality of life. In fact, when left untreated the condition can worsen and cause even greater damage, muscle weakness, and other problems. It’s important to consult your doctor, maintain a healthy weight, manage underlying health problems, and protect your hands particularly if your job requires repetitive movements.

Treatment options for wrist and hand pain is best achieved through a combination of injection in conjunction with graded rehabilitative exercise. Individual programs may include a cortisone shot, regenerative medicine, PRP injection, PRP treatment or stem cell therapy which boosts the body’s natural ability to heal.

If your pain does not resolve after a brief period, contact us so that we may help diagnose the problem and treat the underlying cause.  Do not let pain persist or else it may become chronic.

References

Shiri R, Falah-Hassani K. Computer use and carpal tunnel syndrome: a meta-analysis. Journal of Neurological Sciences 2015 Feb 15;349(1-2). Doi: 10.1016/j.jns.2014.12.037 https://www.ncbi.nlm.nih.gov/pubmed/25582979