What is Carpal Tunnel Syndrome (CTS)?

• In each wrist you have what’s called a “Carpal Tunnel”. The Carpal Tunnel is a tunnel in the wrist with (1) a floor (wrist bones), (2) a roof (a ligament), and (3) body structures filling the hole in the middle (tendons, muscles, and the Median Nerve). The following are pictures of the carpal tunnel:

Carpal Tunnel Syndrome happens sometimes to people who do the same or similar movements of the wrist over and over again for a long period of time, such as a secretary who has typed for years of his or her life. However, it is often times inherited. Damage to this part of the wrist can lead to swelling and pressure on the Median Nerve. This causes numbness, pain, clumsiness, or weakness in the wrist or hand. These symptoms are felt on the palm side of the hand in the thumb, index finger, middle finger, and half of the ring finger. Pain could radiate up the arm as far as the shoulder.

Other injuries or illness that may feel like CTS or are associated with CTS.

• Arthritis
• Sprain
• Fracture
• Diabetes
• Overactivity of the pituitary gland
• Hypothyroidism
• Work stress
• Repeated use of vibrating hand tools
• Cyst or tumor

How CTS is typically diagnosed.

• A physical examination by a doctor
• Electrodiagnositc tests
  • Small electrical shocks are caused by a doctor to determine damage
• Ultrasound

Treatment options for CTS.

• Carpal Tunnel Release Surgery
  • 1 of the 10 most frequently performed surgeries in the U.S.
• Therapy afterwards would be very likely, and would include:
  • Edema control
  • Scar management
  • Desensitization
  • Nerve and tendon gliding exercises
  • Re-strengthening of the forearm and hand
    • Will not begin until at least 6 weeks after surgery
  • Patients with new and mild symptoms seem to recover best
• Steroid injections
  • Make sure to remind doctor of Diabetes if this is chosen
• Anti-inflammatory drugs
• Diuretics
• Night-time splinting
• Median Nerve Gliding Exercises
• Aerobic Exercise
• Posture and Position Training

My Suggestions.

• First, go to your general care doctor, inform him or her of your symptoms, and ask for his or her opinion.
  • I would not have surgery unless it’s absolutely unbearable; because the complications from it could be worse than the pain you’re in now.
• Rest the wrist as often as possible, but don’t stop using it completely.
  • Let the wrist lay in a neutral position while you sleep.
    • Don’t let the wrist bend or curl under your chin near your chest (or wrist positions that look similar to this).
    • This is when a splint would be useful. You can get one from an Occupational Therapist. Do NOT buy a generic one from CVS or Walmart.
  • Do the Nerve Gliding exercises.
    • See the attached sheet for instructions.
    • Run through the sequence of movements 5 times twice a day. Hold each movement for two seconds (one-one thousand, two-one thousand).
  • Do not be tempted to use heat on your wrist.
    • Heat causes blood to flush the area, which may cause:
      • More pressure on the median nerveà more pain
    • Put ice on the wrist when it’s most painful.
      • Always place a cloth between the skin and the ice pack/ ice.
      • Only keep the ice on for 15-20 minutes at a time.
      • Check the skin for redness or burns every 1-minute.
        • Ice pack (gel inside) is colder than ice, so be more attentive to skin if you use the ice pack.
      • This will provide temporary relief, but it will not fix the underlying problem.

References:

Trombly (2002) & National Health Institute (2011)