Carpal Tunnel Syndrome is defined as a compression of the median nerve as it goes through an area of the wrist known as the carpal tunnel. Carpal Tunnel Syndrome is a common ailment that mostly occurs in women between the ages of thirty and sixty. It also occurs in men, especially those who work with their hands. Symptoms of Carpal Tunnel Syndrome include pain, numbness and tingling in the thumb, index, and ring fingers, radiating to the palm. Occasionally, the entire hand may be involved, and pain can travel up the wrist into the forearm. Carpal Tunnel Syndrome is usually caused by repetitive activities that are associated with flexion or extension of the wrist. Any activity that causes the hand or wrist to swell can put pressure on the carpal tunnel and can lead to symptoms of Carpal Tunnel Syndrome. Carpal Tunnel Syndrome can occur during pregnancy in association with fluid retention and the increased pressure that accompanies it.
Symptoms of Carpal Tunnel Syndrome are usually worse at night and upon awakening, due to fluid retention in the hands during sleep. Shaking the hands upon arising may relieve symptoms. Chronic Carpal Tunnel Syndrome may cause the muscles of the thumb to atrophy, leading to weakness and difficulty in grasping.
The diagnosis of Carpal Tunnel Syndrome is made by history and physical exam. There are two typical signs of Carpal Tunnel syndrome. In one, holding the wrist in a flexed position for one to two minutes may reproduce the symptoms of Carpal Tunnel Syndrome. In the other, tapping over the median nerve near the carpal tunnel can produce tingling. These are both considered important diagnostic signs of Carpal Tunnel Syndrome. Nerve conduction velocity tests are also used to make the diagnosis. In this test, the median nerve is stimulated electrically at one point, and the ability of the nerve to conduct that stimulus is measured. An inability to properly conduct this stimulus is suggestive of Carpal Tunnel Syndrome
A variety of techniques can be used to treat Carpal Tunnel Syndrome, including physical modalities such as bracing, stretching, manipulation, ultrasound, and electrical therapy. Alternative therapies are also used, to include herbal remedies, dietary supplements, and acupuncture. Bracing is intended to keep the wrist in a neutral position, giving more room in the carpal tunnel, thereby alleviating compression. The brace can be worn only at night, such as in mild cases, or continuously, such as in moderate to severe cases. Stretching seems to decrease the pressure on the median nerve. When it is effective, the stretching routine should be performed two to three times a day, even after symptoms improve. This is especially true during times of repetitive extension and flexion of the wrist. Manipulation of the wrist, hand and elbow can alleviate mechanical irritation in the carpal tunnel. Manipulation is generally done along with other methods of treatment.
Alternative therapies have been shown in some studies to be beneficial. Vitamin B-6, along with a multivitamin and mineral supplement, has been found to be helpful in some studies. Acupuncture has been found to be helpful in managing the pain due to Carpal Tunnel Syndrome. Acupuncture has been successfully used in patients who have not responded to surgical therapy.
Ergonomic changes can be helpful in improving the symptoms of Carpal Tunnel Syndrome. The wrist should be kept in a neutral position. It can be helpful to change the height of desks, chairs, and computers. Keyboard pads can be helpful in taking pressure off of the wrist while working at a computer, and repetitive activities involving flexion and extension should be avoided.
If conservative care as described above is not helpful. A referral can be made for consideration for steroid injections or surgical correction. These are usually considered as the therapy of last resort.