CARPAL TUNNEL SYNDROME

WHAT HAPPENS CARPAL TUNNEL SYNDROME?

Carpal tunnel syndrome (CTS) is a condition that can cause pain,
tingling, numbness, and weakness in the fingers and thumb. CTS can begin
suddenly or gradually. It often affects both hands. if not treated, it
can lead to permanent nerve and muscle damage. With early diagnosis and
treatment, however, there is an excellent chance of complete recovery.

HOW DOES CTS AFFECT PEOPLE?

The numbness, tingling, and weakness from CTS are due to pressure on the
median nerve. This nerve carries signals between the hand and brain. In
the wrist, the median nerve and several tendons that allow the fingers
and thumb to bend pass through the carpal tunnel - a "tunnel" created by
the carpal (wrist) bone and other tissue. The most common cause of CTS
is swelling or inflammation around the tendons and nerve, which
increases the pressure within the carpal tunnel. This increased pressure
affects median nerve function, causing the symptoms of CTS.

Pressure on the median nerve may cause pain, numbness, and tingling in
these areas.

WHAT ARE THE SYMPTOMS?

If you have CTS, you might feel some or all of these symptoms:

* pain, tingling, and numbness in the thumb, index, middle, and ring 
fingers
*tingling in your entire hand *
pain that shoots from the hand up the arm as far as the shoulder
*a swollen feeling in your fingers - even though they may not be visibly
swollen

You may also notice that:
*your symptoms are worse at night
*your hands feel weak in the morning
*you drop objects more than usual
*you have trouble grasping or pinching objects
*you have trouble using your hands for certain tasks, such as buttoning a
shirt, writing with a pen, or opening a jar lid
*the muscles at the base of your thumb are smaller and weaker than they
used to be

At first the symptoms come and go, usually affected by excessive use of
the hand. when the hand is rested, there may be no symptoms. As the
condition worsens and pressure on the nerve becomes greater, the person
may experience numbness all the time.

WHAT CAUSES CTS?

In most patients with CTS, the cause is not known. However, anything
that causes swelling on the tendons or produces repeated pressure on the
median nerve can lead to CTS or make it worse if the condition already
exists. Causes may include:

Injuries, such as a blow to the wrist. This may break one or more of the
carpal bones and damage the median nerve.
Arthritis-related diseases, such as rheumatoid (ROO-mah-toyd) arthritis. 
These diseases cause pain and swelling in joints and other parts of the 
body. They can cause swelling of tissues in the carpal tunnel, resulting 
in pressure on the median nerve.

Work activities and hobbies that require highly repetitive wrist or 
finger motion, especially in combination with forceful pinching or 
gripping or activities involving vibrating hand tools or instruments 
that put pressure at the base of the palm. Some examples are:
•meat, fish, and poultry processing •construction and carpentry •
electronics assembly •logging and sawmill operations •supermarket 
cashiering and scanning •activities of hairdressers, factory and farm 
workers, and mechanics •needlework or knitting •typing or working at a 
computer keyboard 

Other conditions that may be associated with CTS include:
*pregnancy or use of birth control pills (both may cause swelling in
your hands)
*diabetes
*thyroid diseases
*amyloidosis (am-ill-loyd-DOE-sis), a disease in which a protein substance
collects in body organs

WHO GETS CTS?

Carpal tunnel syndrome can occur at any age. CTS from non-work causes
usually affects people in their 50s, while CTS from work causes is
highest between the ages of 20 and 40. The condition is more common in
women than in men.

HOW IS IT DIAGNOSED?

Your doctor will review your medical history and examine your hand and
wrist. One or all of the following tests may be done to help confirm a
diagnosis of CTS.

Tinel's sign test: Your doctor will gently tap the front of your wrist.
if this causes tingling or pain in your hand or forearm, you may have
carpal tunnel syndrome.

Phalen's sign test: Your doctor will ask you to bend your wrist down as
far as it will go and to hold this position from 15 seconds to three
minutes. if you feel tingling or pain, you may have carpal tunnel
syndrome.

Nerve conduction velocity (NCV) study: This measures the nerve's ability
to send electrical impulses to the muscle. if the electrical impulses
are slowed down in the carpal tunnel, then you probably have CTS.

X-rays of the hands and blood tests may be used to find out if there are
any other medical problems that are causing CTS.

WHAT IS THE TREATMENT?

The goal of treatment is to relieve pain and prevent CTS from getting
worse. The type of treatment you use depends on the severity of your
CTS. It may include one or all of the following:

Splints

A wrist splint may be used to keep the wrist in a straight position
while you sleep. You may be requested to wear a daytime splint if the
symptoms persist during your daily activities. The splint helps reduce
swelling that may be causing CTS. An occupational therapist can make a
splint that will meet your needs.

A wrist splint can keep the wrist straight during sleep, reducing
pressure on the median nerve.

Medicines

Injections of corticosteroids (KOR-ti-co-STARE-oids), or cortisone-like
medications, into the wrist can often reduce the swelling that causes
pressure on the median nerve. These injections often bring significant
relief for many people with CTS. Aspirin or other nonsteroidal
anti-inflammatory drugs (NSAIDs) may also be used to reduce swelling and
relieve pain.

Work Changes

Adjusting your daily work activities may help prevent and/or relieve CTS
symptoms. Here are some ways you can do this:
*Rest your wrists and hands from time to time.
*Alternate tasks to reduce the pressure on your wrist.
*Delegate tasks that bother your hands to other co-workers or family members.
*Modify or change any daily activities, including hobbies, that put too much
 pressure on your wrist.

If you think your CTS may be due to activities at your job, talk to your
doctor and your manager. They may be able to help you make some changes
that will relieve the problem. This could include adjusting your work
area (for example, raising or lowering your desk so you can reach the
computer keyboard more easily) or reducing the amount of time you spend
at particular tasks. An occupational therapist can help you find ways to
modify your activities or suggest tool modifications to put less stress
on your wrists.

Surgery

If medicines are not successful and you continue to have problems,
surgery may be required to relieve symptoms and avoid permanent nerve or
muscle damage. The procedure, called carpal tunnel release, relieves the
pressure on the median nerve. This is usually a simple operation that 
can be done on an outpatient basis.

After surgery, you'll probably have some use of your hand within two 
weeks or so. Usually, you'll regain full use of your hand about six to 
10 weeks after surgery. (Recovery time may be three to four months for 
those people who do a lot of manual labor.)

You may need wrist splints to support your wrist for a short time after 
surgery. You will also have to do exercises to strengthen your fingers 
and keep your joints from becoming too stiff. if you have had CTS for a 
long time, you may need more exercises and physical or occupational 
therapy to regain full use of your hand and wrist.

Results from surgery are generally quite good if severe weakness has not 
developed. You'll probably be able to resume your normal activities, but 
you should avoid activities that put too much stress on your wrist.