Carpal Tunnel Syndrome

Some people might think that carpal tunnel syndrome is a new condition of the information technology age, born from long hours of computer keyboarding. But carpal tunnel syndrome isn't new. Evidence of people experiencing signs and symptoms of carpal tunnel syndrome occurs in medical records dating back to the beginning of the 20th century.

Bounded by bones and ligaments, the carpal tunnel is a narrow passageway, about as big around as your thumb, located on the palm side of your wrist. This tunnel protects a main nerve to your hand and nine tendons that bend your fingers. Pressure placed on the nerve produces the numbness, pain and, eventually, hand weakness that characterize carpal tunnel syndrome. Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the pain and numbness and restore normal use of the wrists and hands.

Some studies suggest that carpal tunnel syndrome can result from overuse or strain in certain job tasks that require a combination of repetitive, forceful and awkward or stressed motions of your hands and wrists. Examples of these include using power tools and heavy assembly line work, such as occurs in a meatpacking plant. If your work or hobbies are hand-intensive, involving a combination of awkward, repetitive wrist or finger motions, forceful pinching or gripping, and working with vibrating tools, you may need to focus on developing strength and flexibility with your wrists and hands.

Carpal tunnel syndrome typically starts gradually with a vague aching in your wrist that can extend to your hand or forearm. Other common carpal tunnel syndrome symptoms include:

  • Tingling or numbness in your fingers or hand, especially your thumb, index, middle or ring fingers, but not your little finger. This sensation 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.

  • Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on palm side of your forearm.

  • A sense of weakness in your hands and a tendency to drop objects.

Other risk factors include:

  • Your sex. 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. You may be significantly more likely to develop carpal tunnel syndrome if close relatives have had the condition. Inherited physical characteristics, such as the shape of your wrist, may make you more susceptible.

  • Certain health conditions. Conditions including some thyroid problems, diabetes, obesity and rheumatoid arthritis can increase your risk. Women who are pregnant, taking oral contraceptives or going through menopause also are at increased risk, most likely due to hormonal changes. Fluid retention may be a cause of carpal tunnel syndrome during pregnancy. Fortunately, carpal tunnel syndrome related to pregnancy almost always improves after childbirth. People who smoke cigarettes may experience worse symptoms and slower recovery from carpal tunnel syndrome than nonsmokers do.

There are no proven strategies to prevent carpal tunnel syndrome, but to protect your hands from a variety of ailments, take the following precautions:

  • Reduce your force and relax your grip. Most people use more force than needed to perform many tasks involving the hands. If your work involves a cash register, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink. This way you won't have to grip the pen tightly or press as hard on the paper.

  • Take frequent breaks. Every 15 to 20 minutes give your hands and wrists a break by gently stretching and bending them. Alternate tasks when possible. If you use equipment that vibrates or that requires you to exert a great amount of force, taking breaks is even more important.

  • Watch your 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 wrist height or slightly lower.

  • Improve your posture. Incorrect posture can cause your shoulders to roll forward. When your shoulders are in this position, your neck and shoulder muscles are shortened, compressing nerves in your neck. This can affect your wrists, fingers and hands.

  • Keep your hands warm. You're more likely to develop hand pain and stiffness if you work in a cold environment. If you can't control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.

When seeking medical attention, your doctor will most likely want to review your signs and symptoms to find out where they're located. One diagnostic key is that the median nerve doesn't provide sensation to the little finger, so symptoms in that finger may indicate a different problem. Another clue is the timing of the symptoms. Typical times when you might experience symptoms due to carpal tunnel syndrome include while holding a phone or a newspaper, gripping a steering wheel, or waking up during the night.

Your doctor will also want to test the feeling in your fingers and the strength of the muscles in your hand, because these can be affected by carpal tunnel syndrome. Pressure on the median nerve at the wrist, produced by either bending the wrist, tapping on the nerve or simply pressing on the nerve, can bring on the symptoms in many people.

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

  • Electromyogram. Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles your doctor wants to study. An instrument records the electrical activity in your muscle at rest and as you contract the muscle. This test can help determine if muscle damage has occurred.

  • Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel.

Most people with carpal tunnel syndrome experience effective treatment with nonsurgical methods, including:

  • Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Splinting is more likely to help you if you've had only mild to moderate symptoms for less than a year.

  • Analyzing your job tasks and assess the amount of repetitive movements you perform with your wrists and hands daily. A thorough ergonomic evaluation of your desk and computer station is very important.

  • Rehabilitation. Your doctor or therapist may suggest exercises to gradually stretch and strengthen your muscles, especially the muscles of your forearm. A Corrective Exercise Specialist is trained to locate and address muscular and functional imbalances that may have contributed to wrist pain. A specific rehab program needs to be designed for each patient for every injury is different.

  • Physiotherapy: Conservative treatment including ultra-sound, electrical stimulation and joint mobilization. Active Release Techniques (ART) is a very effective way to treat carpal tunnel syndrome.

  • Wrist Adjusting: A Certified Chiropractic Sports Physician is trained to adjust the wrist for proper realignment. The elbow shoulder and spine should also be adjusted for proper alignment.

  • Taping: Depending on the cause of your wrist pain, the area may need to be taped for a short period of time to re-establish the integrity of the ligaments in the area.