Carpal tunnel syndrome is not a club to which anyone wants to belong. It is caused by a pinched nerve in the wrist, and can be debilitating to some, career-ending where repetitive motion is required, and limiting to others in what they can accomplish before the condition flares up.
The United States Occupational Safety & Health Administration ranks musculoskeletal disorders like carpal tunnel syndrome among the most frequent work injuries. These injuries also include tendonitis, trigger finger, tendinitis, rotator cuff injuries, and back strains and lower back pains are among the injuries suffered by workers on the job. Nearly two million such injuries occur each year, according to the Occupational Safety & Health Administration.
Carpal tunnel syndrome is caused by several factors. It can be the result of the wrist’s anatomy, how the hand is used, and even the byproduct of underlying health issues. Once it begins, it is difficult to get rid of and requires a long period of treatment to ease symptoms.
WHAT IT IS
The carpal tunnel is actually a narrow passageway located on the palm side of the wrist. Bound by bones and ligaments, the tunnel is the protection for a main nerve in the hand and nine tendons that bend the fingers. When that nerve becomes compressed, it leads to the symptoms of carpal tunnel. The onset is usually gradual, with numbness or tingling in the first iterance affecting the thumb, index and middle fingers. The symptoms will come and go, but gradually worsen and become more frequent.
The numbness, tingling and weakness are attributed to compression of the nerve. But through proper treatment, most find relief and restore function.
The condition usually comes on gradually. Those who suffer from it might first notice numbness and tingling in their fingers, as well as discomfort in the area, including the wrist, usually while performing a minor task like using a phone, holding a newspaper, or navigating a steering wheel. The infirmity may gradually move up the arm, becoming constant.
As the symptoms progress, the hand will become weaker, causing the afflicted to drop objects. This is because the median nerve can weaken the thumb and fingers, which are used to hold objects.
CAUSES OF CARPAL TUNNEL
Anything that compresses, irritates or crowds the median nerve can cause carpal tunnel syndrome. In many cases, it’s a combination of things, and no single factor can be pinpointed.
Some potential issues:
- Injury -- A wrist fracture sustained during high-impact activities or an accident can cause the tunnel to narrow from the swelling and inflammation attributed to the injury
- Rheumatoid arthritis -- A disease usually found in aging people, rheumatoid arthritis can cause swelling and inflammation in the carpel tunnel, impinging on the median nerve.
- Anatomical deformity -- Some people are born with smaller carpal tunnels, which makes them more susceptible to aggravating them with compression.
- Gender - Women are more susceptible to carpal tunnel syndrome than men, perhaps because the tunnel is smaller, making it easier to be compressed.
- Nerve damage -- Diabetes and some other chronic illnesses increase the overall risk of nerve damage, including to the median nerve.
- General inflammation ---Any kind of inflammatory condition in the body can also reach the wrist tendons, causing pressure on the median nerve.
- Fluid build-up -- If the body can’t easily rid itself of fluids, the resulting build-up can increase pressure at the extremities, including the wrist, putting pressure on the tendons and, in turn, the median nerve.
- Other body conditions -- Menopause, obesity, thyroid conditions and kidney failure may all lead to carpal tunnel syndrome.
- Repetitive stress -- Meat cutters, factory workers, newspaper reporters and others who constantly repeat the same tasks using their wrists are susceptible to carpal tunnel syndrome. Even those who use vibrating tools may be at risk, as the machine’s workings cause a stimulation that can affect the median nerve.
As carpal tunnel syndrome worsens, many patients begin to lose sleep and are unable to perform employment activities like typing on a computer keyboard. Left untreated, the damage can become extremely painful and result in permanent muscle and nerve damage.
A doctor will perform a thorough evaluation to determine the patterns of your regular day, which may offer clues to what is causing the condition. The timing of symptom appearance may be a factor, as well as work habits. Imaging tests may be performed to get a closer look at the median nerve and its surrounding bone structure.
An electromyogram may also be performed. This is a test that uses a thin needle electrode inserted into specific muscles. This will evaluate the electrical activity when in use and at rest, giving the doctor an opportunity to evaluate whether muscle damage has occurred.
Another test that may be performed is a variation of the electromyography called the nerve conduction study. In this test, a small shock is passed through the median nerve. The doctors will then determine whether the impulses slow in the carpal tunnel, a sign of impingement.
Many carpal tunnel cases are a matter of simple ergonomics. Adjusting a chair or keyboard level can ease symptoms, and with rest or support of the wrist, the symptoms should fade. Ice packs to reduce occasional swelling are also effective.
Some carpal tunnel sufferers wear wrist splints that help stabilize the wrist and prevent the wrist from getting into painful positions. It can be used during work or at bedtime to firmly hold the wrist in place.
Doctors may also explore using non-steroidal anti-inflammatory drugs like ibuprofen to help pain, or corticosteroids if the over-the-counter medications are not effective.
If none of these help, doctors may consider surgery to relieve pressure on the median nerve by cutting the ligament that is pressing on it. There is a risk of developing scar tissue that can cause further problems, as well as surgery that causes further nerve issues. The usual surgical risk of infection is also a consideration.