CARPAL TUNNEL SYNDROME

By Borimir J. Darakchiev, MD

Carpal tunnel syndrome is a well-known medical condition that has become more commonly diagnosed in the information technology age, possibly related to occupations requiring prolonged computer keyboarding.
The carpal tunnel is a narrow space surrounded by bones and ligaments and is located on the palmar aspect of the wrist. Pressure placed on the median nerve, a major component of the carpal tunnel, produces the numbness, pain and, eventually, hand weakness that characterize carpal tunnel syndrome.

Causes
Carpal tunnel syndrome is caused by pressure on the median nerve. The most common cause of this pressure is swelling or thickening of the ligaments in your carpal tunnel as a result of:

- Other health conditions: rheumatoid arthritis, hormonal disorders — such as diabetes, thyroid disorders and menopause, fluid retention due to pregnancy, or deposits of amyloid, an abnormal protein produced by cells in your bone marrow.
- Repetitive use or injury: Repetitive flexing and extending of the tendons in the hands and wrists, as well as injury to your wrist can cause swelling that exerts pressure on the median nerve.

Who is at risk?
Carpal tunnel syndrome can result from overuse or strain of your hands and wrists in certain occupations that require repetitive, forceful and awkward motions. Examples of these include using power tools — such as chippers, grinders, chain saws or jackhammers. Repetitive computer use and typewriting is commonly assumed to cause carpal tunnel syndrome, although it hasn’t been definitively proven.

Other risk factors include:

Gender: Women are three times as likely as men are to develop carpal tunnel syndrome. The incidence in women peaks after menopause, and the risk of carpal tunnel syndrome also increases in men during middle age.
Heredity: If your close relatives had carpal tunnel syndrome you may be significantly more prone to develop it. Inherited physical characteristics, such as the shape of your wrist, may make you more susceptible.
Certain health conditions: Thyroid problems, diabetes, obesity and rheumatoid arthritis can increase your risk of development the syndrome. Pregnancy, intake of oral contraceptives or going through menopause will also put you at risk, most likely due to hormonal changes. Fortunately, carpal tunnel syndrome related to pregnancy almost always improves after childbirth.
Symptoms

The most common symptoms of carpal tunnel syndrome are:

- Aching pain in your wrist that can extend to the palm side of your hand or forearm. Pain is especially severe at night.
- Tingling or numbness in your fingers or hand, especially your thumb, index, middle or ring fingers, but not your little finger. This often occurs while driving a vehicle or holding a phone or a newspaper or upon awakening. Many people "shake out" their hands to relieve their symptoms.

When to seek medical advice
If signs and symptoms that you think might be due to carpal tunnel syndrome interfere with your normal activities — including sleep — and if they persist, see your doctor. If you leave the condition untreated, nerve and muscle damage can occur.

Making the diagnosis
The most common specialists involved with the treatment of carpal tunnel syndrome are neurosurgeons, hand surgeons and neurologists. This, however doesn’t necessarily imply that your treatment will require surgery. You will be examined by your doctor who will check the sensation and strength of your hand and arm.

If you have signs and symptoms of carpal tunnel syndrome, your doctor may recommend the following diagnostic tests:

-Electromyogram, which measures the tiny electrical discharges produced in muscles. This test can help determine if muscle damage has occurred, or
-Nerve conduction study, to see if electrical impulses are slowed in the carpal tunnel.

These tests are also useful in checking for other conditions that might mimic carpal tunnel syndrome, such as a pinched nerve in your neck. Your doctor may recommend that you see a rheumatologist, neurologist, hand surgeon or neurosurgeon if your signs or symptoms indicate other medical disorders or a need for specialized treatment.

Treatment

Mild symptoms of carpal tunnel syndrome can be temporarily relieved by taking more frequent breaks to rest your hands and applying cold packs to reduce occasional swelling. If these simple measures stop working, other non-surgical treatments such as wrist splinting and medications should be considered. Anti-inflammatory medications, such as Advil or Motrin, often prove effective, as well as corticosteroid injections
Surgery.

Carpal tunnel release

Generally, nonsurgical treatments are more effective if you have only mild nerve impairment. When the pain or numbness of carpal tunnel syndrome persists, a surgical procedure called carpal tunnel release may be the best option.
The goal of the surgery is to release the median nerve from the pressing thickened ligament by cutting the latter. Surgery usually results in marked improvement in more than 70% of the cases, but you may experience some residual numbness, pain, stiffness or weakness.

If surgery appears to be the best alternative for relieving your symptoms or preventing further muscle atrophy (wasting), be sure to talk with your surgeon about the procedure that will work best for you and with your plans to return to your previous activity levels, both at work and at home.

Prevention
Some simple guidelines to protect your hands and wrists include:

- Reduce your force and relax your hand grip: most people use more force than needed to perform many tasks involving the hands.
- Take frequent breaks: every 15 to 20 minutes give your hands and wrists a break by gently stretching and bending them.
- Watch your posture and form: avoid bending your wrist all the way up or down. A relaxed middle position is best. If you use a keyboard, keep it at elbow height or slightly lower.

Alternative medicine
Yoga, heat application, massage, chiropractic and osteopathic manipulation and water therapy (hydrotherapy) have all shown some benefit in the treatment of carpal tunnel syndrome.

You may have to find a treatment that works best for you. Still, always check with your doctor before trying any complementary or alternative treatment.