Carpal Tunnel Syndrome: Get the “Smack Down” on Hand Pain

Hand and finger pain, numbness, tingling, or weakness taking the fun out of your function? You may be suffering from a common condition known as carpal tunnel syndrome (CTS).
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CTS is the most common upper extremity nerve compression syndrome, occurring in a percent of the population, with 7.2% primarily related to occupational work-related injuries and repetitive type upper arm, hand and finger motions.

Anatomy

​The CTS is a narrow passageway that connects the upper arm to the hand. The floor of the tunnel is formed by the eight wrist or carpal bones, and the roof, but a strong band of fibrous tissue, the transverse carpal ligament. Nine flexor tenders, encased in a synovial sheath that lubricates the tendons, passes through the tunnel along with the median nerve, which originates from the plexus of nerves in the neck. The median nerve provides feeling in the thumb, index, middle and outside portion of the ring finger. The nerve controls the muscles of the distal forearm and around the base of the thumb.

In a Pinch

​The condition occurs when the tunnel becomes narrowed, such as when the synovium around their flexor tendons becomes inflamed, putting pressure on the median nerve. Inflammation can take up space in a tunnel crowding the nerve and eventually lead to symptoms.  Most cases are caused by a combination of factors but is generally related to repetitive hand and wrist motions, or activities that involve extreme flexion or extension of the hand and wrist, for a prolonged period of time.  The tendons become inflamed putting pressure on the nerve. Conditions such as hypothyroidism, rheumatoid arthritis, obesity, diabetes and in some cases a pregnancy can cause pressure as well. Women tend to have more frequency as often the carpal tunnel is smaller than in men.

Feel the Burn

​In most cases the condition begins gradually.  Common symptoms include numbness, tingling, burning and pain primarily in the palm of the hand, thumb, index and middle fingers. Think of the median nerve as an electrical cable, capable of sending shock like sensations, which may also radiate up the forearm toward the shoulder. Worth mentioning is that a number of patients presenting with a diagnosis of CTS in fact have nerve compression in the neck area which can often imitate CTS with referred symptoms along that nerve distribution. Often, a double-crush syndrome can occur where there is pressure both coming from the neck and directly in the carpal tunnel. As compression continues, weakness, clumsiness in the hand, and frequent dropping of items becomes more pronounced. Difficulty with performing fine movements involving the thumb such as picking up a coin, buttoning your clothes, or holding a pen/writing can occur. Symptoms can wax and wane however as the condition worsens, the frequency duration and intensity of all increases. Pain and tingling at night are very common because most people sleep with their wrists in a bent position.

How Do You Know?

​Examination and orthopedic tests can be performed to rule out CTS. Electro diagnostic test including NCV-EMG are performed to measure the electrical activity in the muscles and see where the nerve flow may be impeded. Again, including a screen of the cervical area both with a physical examination and including in the nerve conduction studies, will help in accurate management of the condition.

Get a Grip

Early intervention may be possible to slow or stop the progression of the condition although most people will worsen over time without some form of treatment. Anywhere from 28 to 60% of patients recover without treatment of 32 to 58% can worsen over time depending upon the severity and continuation of provocative activities. Physical therapists are well trained to assess and evaluate people with CTS. Management may include manual therapy to the cervical spine and extremity, including dry needling, nerve and tendon glides, and eccentric training and flexibility exercises, lifestyle changes, such as taking frequent breaks, stretching and addressing posture, body mechanics, and ergonomics are paramount in education on the proper set up of your computer, such as revising the mouse and keyboard, using bigger handles/grips on tools and sporting equipment, and alternating postures/activities can lead to decreased compression. Wearing a brace or splint at night will help you from bending your wrist while sleeping and may be necessary to wear during the day if prone to positions that aggravate the condition. Medications may include anti-inflammatories, or steroid injection to reduce swelling.

If nonsurgical intervention does not relieve your symptoms after period of time and in long-standing cases of persistent numbness, weakness and muscle atrophy, surgery is an option. A carpal tunnel release is performed to relieve pressure on the median nerve by cutting the ligament that forms the roof of the tunnel. For most, surgery will improve symptoms and reduce pain and weakness. But again, before you decide to slice and dice, be certain to have a thorough screening to rule out cervical involvement.

So…don’t allow hand and finger pain to put a squeeze on your fun! Visit one of our locations to get your condition under control.

Remember… Motion is Lotion!

Dr Allie

​References include Arthritis Foundation, Mayo Clinic, NIH