The carpal tunnel is a narrow passage located on the palm side of the wrist (made up of bones and tough band of tissue), that protects the main nerve in the hand and nine tendons that bend the fingers. Carpal Tunnel Syndrome (CTS) occurs when the median nerve in the wrist gets compressed, causing pain, tingling sensations and numbness in the hand and fingers. Generally, these sensations develop gradually and become worse during the night. CTS mainly affects the thumb, and the index and middle fingers.
CTS can affect both men and women. The symptoms of the condition include numbness or tingling sensation in the hand and fingers, thumb weakness, dryness of the skin in the fingers, aches in the wrist, palm or forearm and trouble in lifting objects. These can range from mild to severe and differ from one person to another. As the intensity of the condition increases, it may cause the person difficulty in holding a small object, hardship with performing manual tasks and lose sensation in the fingers.
How Does CTS Occur?
Rather than being a problem with the median nerve, CTS is usually the result of several factors that put excessive pressure on the nerve and tendons in the carpal tunnel. The tendon that travels through the tunnel is wrapped by a sheath and lubricated by synovial fluid. This keeps the tendon sliding freely inside the sheath. For patients with CTS, the tendon or sheath tightens and creates swelling (as extra synovial fluid is produced to cure the excess friction). If left untreated, the condition can result in tendonitis and/or tenosynovitis.
- Repetitive work: Overuse of the hands associated with highly repetitive tasks like computer typing, line work, sewing, knitting or playing musical instruments. Activities that require strenuous gripping, wrist flexion and exposure to vibration such as using chainsaws, jack hammers, assembly packing, hand buffers, or grinders can irritate the carpal tunnel.
- Certain medical and other conditions: Arthritis, diabetes, hypothyroidism, obesity and lupus, as well as use of birth control pills, pregnancy, menopause.
- Injuries: Sprains, fractures or crush injuries of the wrist that causes misalignment of the carpal bones. Such injuries may tighten the transverse carpal ligament (the floor of the tunnel), narrowing the carpal tunnel and compressing its contents.
- Genetics: Reports suggest that there is a genetic link to CTS. A person may have an increased risk of developing the condition if other members of their family have or had it. It is estimated that about 1 in 4 people with this CTS have a close relative who suffers from the condition.
Treatments for carpal tunnel syndrome should start as soon as the condition is medically diagnosed. Underlying causes such as diabetes or arthritis are treated first. In addition to resting the hand, the patient is advised to avoid activities that could worsen the condition. Wearing splints to immobilize the wrist and prevent further damage due to twisting or bending may be recommended. Non-surgical modalities such as chiropractic and physical therapy are proving very effective in treating CTS and helping patients restore mobility and function.