Health Articles & Information

About Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a medical condition in which the median nerve is compressed at the wrist causing symptoms like tingling, numbness, night time wakening, pain, coldness, and sometimes weakness in parts of the hand.

Carpal Tunnel Syndrome Treatment and Prevention

There has been much discussion as to the most effective treatment for CTS. However, treatments can be generally divided into six basic categories:

1) Reversible causes - Some causes of carpal tunnel syndrome are amenable to medical therapy. Treatment of these conditions tends to reverse the symptoms of carpal tunnel syndrome. These causes include metabolic disorders such as hypothyroidism.

2) Immobilizing braces - A splint can keep the wrist straight.The importance of wrist braces and splints in the carpal tunnel syndrome therapy is unknown for many people. Many health professionals suggest that, for best results, one should wear them at night and, if possible, during the activity primarily causing stress on the wrists, but they can be limiting and uncomfortable to wear. The problems of limitation of movements (especially fingers) and discomfort have been improved with a new type of brace (Policarpal). This brace can be comfortably worn night and day because it does not have a splint and the fingers can move freely; it requires 15 days of use to be effective.

3) Physiotherapy - Physiotherapy offers several ways to treat and control carpal tunnel syndrome. Manual treatment that includes deep friction massage can help manage the swelling that is a factor in nerve compression. This is combined with manual stretches to the tendons to the fingers and wrist. Another modality of treatment is ultrasonic therapy, which in some cases may work as a treatment by itself, but is better when used in combination with other physiotherapy treatments. There are numerous other techniques offered by competent occupational and physical therapists that can aid in the control of carpal tunnel symptoms. While therapy is useful for short or long term management of "mild to moderate" carpal tunnel symptoms, one must note that it controls the process, but does not cure it. Physical therapy tends to be ineffective in even temporarily controlling symptoms of "moderate to severe" severity....

4) Localized steroid injections - Steroid injections can be quite effective for temporary relief from symptoms of CTS for a short time frame while a patient develops a long term strategy that fits with his/her lifestyle. In general, medical professionals only prescribe to localized steroid injections until other treatment options can be identified. For most patients, permanent relief requires surgery.

5) Prioritizing hand activities and ergonomics - Any forceful and repetitive use of the hands and wrists can cause upper extremity pain. While avoiding activities that cause repetitive stress is an option that can help avoid the pain, it causes people to curtail their careers, forfeit earnings and give up whole segments of their lives. Our self esteem as human beings and contributors at home, at work and at recreation is directly tied to the way we use our hands. Giving up activity is a poor option for most people.

More frequent rest can be useful if it can be orchestrated into one's schedule, but rest is not very practical in today's active work and play environments. It has been shown that taking multiple mini breaks during the stressful activity is more effective than taking occasional long breaks. There are computer applications that aid users in taking breaks. All of these applications have recommended defaults, following the most effective average break configuration, which is a 30 sec. pause every 3 to 5 minutes (the more severe the pain, the more often one should take this break). Before investing in these types of programs, it's best to consult with a doctor and research whether computer use is causing or contributing to the symptoms, as well as getting a formal diagnosis.

More pro-active ways to reducing the stress on the wrists which will alleviate wrist pain and strain involve adopting a more ergonomic work and life environment such as using an ergonomic keyboard (and perhaps switching from a QWERTY key layout to a more efficient Dvorak Simplified Keyboard layout). Early studies claimed that ergonomic keyboards significantly reduced wrist stress; meta-analyses of these studies, however, report significant flaws in the research and question the usefulness of such keyboards.

It is also important that ones body be aligned properly with the keyboard. This is most easily accomplished by bending ones elbows to a 90 degree angle and making sure the keyboard is at the same height as the elbows. Also it is important not to put physical stress on the wrists by hanging the wrist on the edge of a desk, or exposing the wrists to strong vibrations (e.g. manual lawn mowing). Position the computer monitor directly in front of your seat, so the neck is not twisted to either side when viewing the screen.

Exercises that relax and strengthen the muscles of the upper back can reduce the risk of a double crush of the median nerve. Spinal manipulations performed by an osteopath, physical therapist or chiropractor may be appropriate to relieve compression of the nerve.

6) Medication and diet - Using an over-the-counter anti-inflammatory such as aspirin or ibuprofen or Naproxen can be effective as well for controlling symptoms. Pain relievers like Tylenol will only mask the pain, and only an anti-inflammatory will affect inflammation. Non steroidal inflammatory medications theoretically can treat the root swelling and thus the source of the problem. Oral steroids (prednisone) does the same but is generally not used for this purpose due to significant side effects. The most common complications associated with long-term use of anti-inflammatory medications are gastrointestinal irritation and bleeding. Also, some anti-inflammatory medication have been linked to heart complications. No one should rely on these type of medications for chronic long-term pain without a doctor's supervision.

A more aggressive pharmaceutical option is an injection of cortisone, to reduce swelling and nerve pressure within the carpal tunnel.

Dietary changes can provide the body with the necessary nutrients needed to repair nerves and help reduce inflammation. With this, pressure on the nerve may be reduced, allowing it to heal. No specific vitamin or nutrient has been shown to have a noticeable anti-inflammatory effect, but taking a diverse multivitamin may have a noticeable effect on reducing inflammation in the body. One could argue that diet and vitamins have a small effect on carpal tunnel syndrome, similar to placebo. Their effect would be expected to be negligible except in the most mild of cases.

Carpal Tunnel Release Surgery

When visiting a hand surgeon, the first step would be examination of the hands and a review of the symptoms. If a condition other than carpal tunnel syndrome is present, the doctor will suggest the appropriate treatment. If CTS is suspected, depending on the severity and the situation, (s)he will first prescribe non-operative treatment with splinting and anti-inflammatory drugs. A test conducted on the nerve will positively determine whether or not it is compressed and if carpal tunnel syndrome is indeed the diagnosis.

If all the symptoms go away with splinting and medication, then surgery will not be necessary. If not, then the "carpal tunnel release" surgery is recommended. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and likely will come to surgical treatment.

Carpal tunnel surgery is usually performed by an orthopaedic or plastic surgeon; some neurosurgeons and general surgeons also perform the procedure.

Long Term Recovery

The early signs of carpal tunnel syndrome should not be ignored. Early denial of carpal tunnel symptoms is a sure way to lead to progressive symptoms.

Most people who find relief of their carpal tunnel symptoms with conservative or surgical management find minimal residual or "nerve damage". Long-term chronic carpal tunnel syndrome (typically seen in the elderly) can result in permanent "nerve damage", i.e. symptoms of numbness, muscle wasting and weakness.

Many mild carpal tunnel syndrome sufferers either change their hand use pattern or posture at work or find a conservative, non-surgical treatment that allows them to return to full activity without hand numbness or pain, and without sleep disruption. Other people end up prioritizing their activities and possibly avoiding certain hand activities so that they can minimize pain and perform the essential tasks.

Changing jobs is also commonly done to avoid continued repetitive stress tasks. Others find success by adjusting their repetitive movements, the frequency with which they do the movements, and the amount of time they rest between periods of performing the movements.

In summary, one has the choice of controlling the symptoms with any of the non-surgical options listed, or correcting the condition with surgery.

Source: Wikipedia.org