Carpal tunnel syndrome (CTS) is a very common condition that I see in my office every week. The main cause of CTS is increased pressure within the carpal tunnel, which consequently applies compressive force to the median nerve. The increased pressure upon the median nerve causes nerve ischemia (restriction in blood flow to the nerve), which is the source of the motor and sensory dysfunction experienced by patients inflicted with CTS.
The carpal tunnel is just that, a tunnel. Inside the tunnel lies the median nerve and 9 tendons of the flexor muscles. The transverse carpal ligament forms the roof of the carpal tunnel and the carpal bones are responsible for creating the bottom and side boundaries of the carpal tunnel. CTS is a condition in which the median nerve becomes compressed within the carpal tunnel.
Increased pressure on the median nerve can affect the structures innervated by the median nerve distal to the wrist. The median nerve branches to give off a recurrent branch, which provides motor innervation to the muscles of the thumb: the abductor pollicis brevis, the flexor pollicis brevis, and the opponens pollicis. It also gives off digital cutaneous branches, which supply sensory innervation to the skin of the first 3 fingers and half of the fourth finger on the palmar side. In addition, the median nerve supplies motor innervation to the first and second lumbricals of the hand.
Signs & Symptoms
Typical symptoms are pain and paresthesias of the palmar surface of the hand, close to the thumb and index finger, which is worse at night and often awakens the patient from sleep. Patients with CTS also complain of sensory symptoms such as dull pain and tingling sensation in the thumb, index, and middle finger or paraesthesia and stiffness of hand at night primarily, tingling sensation of fingertips, not entire hand. Atrophy in the thenar (thumb) muscle, weakness or clumsiness of hand, dry skin, swelling or color change in the hand also can be seen in some cases.
Risk factors associated with the development of CTS include female gender, pregnancy, diabetes, hypothyroidism, and rheumatoid arthritis.
There are many treatment options including:
- Chiropractic Care
- Laser Therapy
- Active Rehabilitation
Lifestyle Modification can help to minimize your risk of developing CTS:
- Reduce your force and relax your grip. Most people use more force than needed to perform many tasks involving their 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. Give your hands and wrists a break by gently stretching and bending them periodically in order to stretch out the forearm muscles. Hold each stretch for 20 seconds. 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 elbow 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.
Eplasty. 2013; 13: ic8. Published online 2013 January 18. PMCID: PMC3554258
Carpal Tunnel Syndrome
For more information please contact Dr. Nekessa Remy at firstname.lastname@example.org or call us at 905-820-7746.