Carpal Tunnel Syndrome

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Category: Soft Tissue Rheumatism Articles Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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REPETITIVE MOTION - BAD FOR YOUR WRISTS!

Do you perform certain motions over and over at work or at play? Do you experience numbness in your palms or fingers? Are you pregnant or taking birth control pills or hormone replacements? Do you have diabetes, hypothyroidism or rheumatoid arthritis? You could be at risk of developing carpal tunnel syndrome like Paulette.

Paulette, a secretary by day and an avid tennis player by night, started experiencing numbness in her right hand, especially the wrist, palm and all fingers, except for her pinky. She suffered with intermittent shooting pain, weakness, pins and needles, and burning in her right hand, which sometimes left her unable to grip her tennis racket. After several bouts of what she called “clumsiness” or losing grip of what she was holding and dropping it, she felt it was time to see her doctor. During her visit, her doctor examined her hand and wrist; he decided to order a few blood tests. When she returned for a follow-up, her doctor told her that her thyroid level was low, meaning she had hypothyroidism. He then diagnosed her hand pain as carpal tunnel syndrome and treated her with thyroid medication, anti-inflammatories and told her to wear a wrist splint. Within a few months, Paulette was back to normal and back to swinging her racket with proper body mechanics and more spunk than ever.

TUNNELING IN OUR BODY

Tunnel syndrome can occur in parts of the body other than in the wrist and is due to narrowing of the space within the tunnel that houses the nerves and ligaments. Think of an underwater road tunnel, with a normal volume of automobiles driving through it. No problems, right? But what if there was an accident (injury)? The pile up (cyst) would take up some of the space within the tunnel, causing the other cars to slow down. Also, let’s suppose the tunnel was actually composed of a flexible material and not solid concrete. If an over abundance of water on the exterior (edema or inflammation) was present, the extra pressure on the tunnel would make it narrower and slow down traffic (numbness and tingling due to sensory nerve compression) or even create a traffic jam (weakness or sometimes loss of movement due to motor nerve compression).

HOUSE OF THE MEDIAN

The median nerve, which lives in the tunnel within the carpal, Greek for wrist, provides sensation to the palm of the hand, thumb, index, middle finger and ring finger, but oddly enough not to the pinky. It is protected by eight carpal bones and a band of ligaments. However, when pressure increases on the tunnel, the sensory nerve fibers within the median nerve, which are quite sensitive to ischemia (deprivation of blood supply), can cause tingling and numbness in the hand. In more severe cases, when the motor nerve fibers, also within the median nerve, are compressed, the patient may develop weakness of the hand.

REPETITION, REPETITION, REPETITION

Repetitive motion seems to be an important culprit in the development of carpal tunnel syndrome (CTS) because the act of extending and flexing the wrist increases pressure on the carpal tunnel. Activities involving repetitive wrist motion can include frequent knitting or crocheting, playing a guitar, piano or violin, typing or keyboarding, bowling, golfing, playing tennis or racquetball, or using an adding machine or other tools that require overuse of the hands. However, if such activities along were the cause of carpal tunnel, wouldn’t all tennis players, golfers, typists, pianist, violinists, accountants, bowlers and guitarists have CTS? Obviously, there are certain risk factors that, alone or in combination with repetitive motion, make you more prone to developing this condition.

RISK FACTORS TO CONSIDER

Recent studies have shown that the occurrence ratio of CTS is about 1 to 4 people out of 1000. Pregnancy, menopause, hormone replacement therapy and birth control pills are known to increase swelling or edema, which can put pressure on the body’s tunnels. It’s no wonder why CTS seems to affect twice as many women than men, especially between the ages of thirty and fifty. Further underlying conditions such as rheumatoid arthritis, diabetes, hypothyroidism, smoking, obesity, and vitamin B6 or B12 deficiency also can have a similar affect, narrowing the tunnel and compressing the nerve. Finally, due to genetic predisposition, the tunnels in our body are as individual as we are; some are big and some are naturally small.

WHAT DOES IT FEEL LIKE?

Patients with CTS describe aching in the upper arm along with tingling, numbness or pain in the thumb, index, middle and ring fingers, either unilaterally (one side) or bilaterally (both left and right). Often, patients with a longer case of CTS lose the ability to flex their thumb, grip properly or make a full fist due to atrophy (loss of muscle) of the adductor and abductor pollicis brevis (muscles in the thumb).

TREATING BOTH TEMPORARY AND PERMANENT

Treating CTS depends on the severity, duration and underlying condition. If the patient has hypothyroidism, diabetes, rheumatoid arthritis, or vitamin deficiency, these conditions should be controlled first, which may resolve the CTS. In addition, weight reduction, smoking cessation, stopping birth control pills or hormone replacements may reverse the effects of CTS. However, if the CTS has progressed, cortisone injections into the carpal tunnel, anti-inflammatory drugs, wearing a wrist splint, physical therapy, deep muscle massage, breaks in repetitive motions with stretching exercises and an ergonomically sound work station will probably suffice as treatment. Lastly, if six to eight months of the above conservative treatment does not alleviate symptoms and restore daily function, surgery to free the median nerve would be the next option.

Fortunately, with an early diagnosis and proper treatment, CTS can be reversed and function can be restored. So take an active role in managing your risk factors and use your wrists properly. Your hands are relying on you, as you rely on them.

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