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Carpal Tunnel Syndrome: Anatomy, Causes, and Treatment

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If you have pain in your hand, fingers, or thumb, you may be suffering from a condition called carpal tunnel syndrome, or CTS. The American College of Rheumatology reports that carpal tunnel syndrome affects 4 to 10 million Americans each year, with peak incidence occurring in women in their mid 50's. When carpal tunnel syndrome strikes, you should learn the steps you need to take to understand the condition and to get started on the correct treatment right away.

Symptoms of Carpal Tunnel Syndrome

There are a specific set of symptoms that typically occur in people with CTS. Symptoms of CTS may include:

  • Pain in your thumb, index and middle fingers
  • Numbness or tingling in your hand
  • Difficulty grasping items or performing tasks that require dexterity or fine motor skills
  • Weakness in your hand or thumb
  • Visible atrophy of the muscles around your thumb

If you have any of these symptoms, check in with your doctor right away to get an accurate diagnosis of your condition and to get started on the correct treatment.

Anatomy of the Carpal Tunnel

Understanding the anatomy of the carpal tunnel can help you understand why you feel certain symptoms and why specific treatments can help your condition.

The carpal tunnel is formed by your wrist bones, called carpals, and the transverse ligament that crosses over these bones on the palm-side of your hand. This creates an anatomical tunnel where specific structures pass through to get to your hands and fingers. Your have 2 carpal tunnels; one in each wrist.

There are 9 tendons that cross through your wrist under the carpal tunnel. The tendons arise from muscles in your forearms and work to flex your fingers and thumb. Your median nerve crosses through the carpal tunnel along with these tendons. The median nerve delivers sensory and motor information to your thumb and first two fingers. You ring finger may also be slightly innervated by your median nerve.

When your median nerve becomes compressed within the carpal tunnel, symptoms of CTS may result. So how does your nerve become compressed, and what activities may cause carpal tunnel syndrome?

Causes of Carpal Tunnel Syndrome

The cause of carpal tunnel syndrome is compression and irritation of your median nerve as it courses through the carpal tunnel. The nerve is very sensitive, and certain positions and postures can irritate it, sending pain or tingling into your hand and fingers.

Carpal tunnel syndrome is considered a repetitive strain injury (RSI). This means that prolonged positions or actions with your arms and wrists place increased stress and strain on the median nerve, irritating the nerve and its surrounding tissues.

Positions and activities that can irritate your median nerve and cause CTS may include:

  • Prolonged typing, especially in a position where your wrist is flexed forward
  • Using a mouse, again with your wrist in flexion
  • Sewing and knitting
  • Using heavy machinery that causes vibration
  • Excessive writing
  • Prolonged hand and finger use
  • Osteoarthritis to the wrist and thumb joints

Of course, sometimes CTS can occur for no apparent reason, even if you do not engage in these activities. That is why it is important to visit your doctor whenever hand, wrist, and finger pain strike so you can start on the right road to successful treatment.

Diagnosing Carpal Tunnel Syndrome

When visiting your doctor with hand pain or symptoms of carpal tunnel syndrome, he or she may perform various tests and measures to confirm your diagnosis and to rule out other problems that may cause symptoms that are similar to CTS. Diagnostic tests that may be ordered to diagnose carpal tunnel syndrome may include:

  • Electromyography (EMG)
  • X-Ray
  • MRI
  • CT scan

The EMG test is considered the gold standard for diagnosing carpal tunnel syndrome. During this exam, small needles are inserted into areas of your neck, arm, and hand. Small electrical shocks are transmitted through the needles, and the speed at which those electrical signals travel through your median nerve help to diagnose CTS. If there is slowing of the electrical signal as it crosses through the carpal tunnel via your median nerve, carpal tunnel syndrome is typically diagnosed.

Your doctor will also make note of your symptoms and their behavior and may take measurements of your grip and fine motor strength. Your wrist and finger range of motion may also be measured. The results of diagnostic testing combined with your subjective complaints and objective measures can help confirm the diagnosis of carpal tunnel syndrome.

Sometimes, you may have hand pain, tingling, or weakness caused by a different problem. Other conditions that may cause symptoms similar to CTS may include:

  • Cervical radiculopathy
  • Ulnar nerve entrapment
  • Wrist arthritis
  • Thumb joint arthritis
  • Diabetes
  • Thyroid disease
  • Wrist tendonitis
  • Raynaud's phenomenon 

Because so many other conditions may present like carpal tunnel syndrome, it is important to consult with your doctor or other healthcare professional to get an accurate diagnosis and to start on treatment right away.

Treatment for Carpal Tunnel Syndrome

When first diagnosed with carpal tunnel syndrome, your doctor may give you treatment ideas to start managing your condition. The various treatments are designed to help manage the inflammation around your median nerve and to improve the way your wrist and hand move.

When managing inflammation, it is helpful to understand the inflammatory process and how your body works to heal injured tissue.

When your median becomes inflamed, there will be certain signs and symptoms that occur. These may include:

  • Redness
  • Swelling
  • Pain
  • Increased tissue temperature

These symptoms occur because of the increased blood flow to your nerve and wrist after injury. The extra blood brings specialized cells to the tissue to help clean the injured area and prepare it for healing. Extra oxygen and nutrients are also brought in to start rebuilding the tissue. During this time, it is thought that excessive circulation may impede range of motion and actually prevent normal mobility from occurring. By controlling this blood flow and excessive swelling, you may actually be able to quickly return to normal activity with little or no pain.

Heat and Ice for Carpal Tunnel Syndrome

When inflammation first strikes, it is helpful to remember the R.I.C.E. acronym. This stands for rest, ice, compression, and elevation. Resting the tissues helps to take stress off of your median nerve to create an environment where healing can take place. Ice and compression control the excessive blood flow and swelling to your wrist and hand, and elevation uses the force of gravity to keep swelling to a minimum, preserving wrist range of motion.

Some professional argue that the R.I.C.E. protocol focuses too much on rest, leaving your wrist and hand tissues to significantly atrophy. Some rehab pros prefer using the P.O.L.I.C.E. acronym, standing for protection, optimal loading, ice compression, and elevation. Protection and optical loading eliminate the rest phase of healing and allows you to first protect the injury and then slowly start to get it moving.

After a few days of icing, switching to heat may be necessary to help open up blood vessels and promote mobility around your wrist. This can bring in fresh oxygen and help improve blood flow to your median nerve. Heat can also soothe sore muscles around your wrist and hand.

Since using both ice and heat may be necessary to treat your CTS, it may be a good idea to find a therapy wrap that can be used as either a cold pack or a hot pack. The ElastoGel Hot/Cold Wrist Wrap is the perfect therapy device to get started on treating the inflammation that may occur with carpal tunnel syndrome. This wrap fits snugly around your wrist, and it can be used as ice for initial cooling, and then as heat to improve circulation and mobility as healing progresses.

Another heat and ice wrap that can provide firm compression is the PolyGel ThermoActive Ice/Heat Wrist Support. This wrap offers both ice and heat, and allows you to use a hand pump to provide a customized amount of wrist and hand compression. This helps to control swelling and to act as a stabilizing brace for severe cases of carpal tunnel syndrome.

Be sure to check in with your doctor before treating your carpal tunnel syndrome to be sure you are using heat and ice properly.

Medication

When first diagnosed with carpal tunnel syndrome, your doctor may prescribe medication to help manage your pain. Anti-inflammatory drugs may be used to decrease inflammation around your median nerve. While these medications can help control your pain, they must be used cautiously, as there may be side effects that can be detrimental to your health. Again, check with your doctor before taking any medicine for your carpal tunnel syndrome.

Physical Therapy and Exercise for Carpal Tunnel Syndrome

Research shows that physical therapy can be an effective treatment for carpal tunnel syndrome. Your PT may use heat and ice with compression to help control the inflammation. Other anti-inflammatory treatments, like ultrasound or iontophoresis, may be used as well.

The most effective treatment in physical therapy for CTS is exercise. Exercises typically include nerve gliding techniques to keep your median nerve mobile while it is healing. Studies show that performing nerve and tendon gliding exercises can improve wrist and hand mobility while helping to improve hand function and decreasing pain.

Sometimes, physical therapists use paraffin baths to help improve mobility and circulation to your median nerve. Paraffin is a wax that is applied to your wrist and hand by dipping your hand into a wax bath. The wax heats your wrist and hand, providing much needed circulation and mobility to the tissues around the tendons and nerve in the carpal tunnel.

Your physical therapist can also help determine if a specific activity is a possible cause of your carpal tunnel syndrome. He or she may ask you to adjust your workspace to limit stress and strain on your wrists. Specialized wrist supports for your keyboard or mouse pad may be used to keep your wrists in a neutral position while working to help lessen stress on your median nerve.

Bracing For Carpal Tunnel Syndrome

Many people with carpal tunnel syndrome benefit from using a special brace to help support their wrist. This support helps to keep pressure off your median nerve and allows healing to take place.

A wrist cock-up splint may be prescribed for your CTS. These splints are typically custom molded and keep your wrist in a slightly extended position to take pressure off your median nerve. Many people wear these splints at night while sleeping, and using them for work situations may be difficult.

If splinting is warranted for your CTS, you may benefit from a small compression wrap that supports your wrist and thumb. Wraps, like the Adjustable Compression Wrist Support Wrap by ICEWRAPS Fitness can provide support while still allowing you to work normally.

By controlling inflammation with ice and heat, by using a brace, and by participating in an active physical therapy program, you may be able to effectively manage your carpal tunnel syndrome.

Surgery for Carpal Tunnel Syndrome

What if you attempt conservative measures and your symptoms persist? Are there any other options for carpal tunnel syndrome?

For severe cases of carpal tunnel syndrome that fail to improve with conservative management, surgery may be considered. The surgery for CTS involves your surgeon making a small incision in the palm of your hand. Then, specialized instruments are used to cut away the fibrotic and swollen transverse ligament that comprises the hood of the carpal tunnel. This helps to get pressure off of your median nerve, allowing it to heal.

Once the surgery is complete, your incision will be sutured and a bandage will be applied to your hand and wrist. Follow your surgeon's advice for proper post-operative management of your carpal tunnel release surgery.

After surgery, many people benefit from following the R.I.C.E. protocol to manage the pain and swelling that comes with surgery. Use ice for the first 2 or 3 days to control the swelling and pain that occurs after surgery. After a few days of ice, switching to heat may be beneficial to bring in fresh blood and to improve tissue mobility. Be sure to listen to your doctor about using heat or ice after surgery.

A few weeks after surgery, you should be feeling well enough to start gaining hand and wrist mobility once again. You may benefit from a course of physical therapy or occupational therapy to help improve scar mobility and to improve the range of motion and strength of your hand and wrist. Your therapist may recommend you continue using a wrist splint or brace during the weeks following surgery to ensure that median nerve compression remains minimal while healing is taking place.

You should be back to your normal activities about 6 to 8 weeks following surgery. Be sure to make some modifications to your work environment to minimize stress and strain to your median nerve so you do not irritate the tissues and start on the road to carpal tunnel syndrome again.

An Ounce of Prevention

It is said that an ounce of prevention is worth a pound of cure, and this holds true for carpal tunnel syndrome. By making a few minor adjustments at work or home, you may be able to prevent the pain and weakness that comes with carpal tunnel syndrome.

First, make some modifications to your work environment to prevent CTS. If you work with heavy machinery that causes significant vibration, you must take frequent rest breaks and wear protective gloves that absorb some of the shock of the equipment.

Office workers who spend countless hours at a computer terminal must be sure their office is configured ergonomically. That means that your computer monitor should be slightly below eye level and that your posture must be well supported in an upright position. Wrist supports may be needed for a keyboard and mouse pad to help keep your forearms and wrists in a neutral position. Frequent rest breaks - even for a minute or two - may be warranted to prevent carpal tunnel syndrome.

Regardless of your profession, you should stop occasionally and perform gentle wrist stretches and nerve or tendon grinding exercises. This can help maintain adequate mobility of the median nerve and tendons in the carpal tunnel and prevent the pain and inflammation that comes with carpal tunnel syndrome.

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