Carpal Tunnel Syndrome - What Is Carpal Tunnel Syndrome?

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What Is Carpal Tunnel Syndrome?

The Physiology Of Carpal Tunnel Syndrome

At the base of the palm is a tight canal or “tunnel” through which tendons and nerves must pass on
their way from the forearm to the hand and fingers. The nerve that passes through this narrow tunnel
to reach the hand is called the Median Nerve. This narrow passage between the forearm and hand is
what is known as the "Carpal Tunnel".

The Carpal Tunnel is normally quite snug and there

is just barely enough room in it for the tendons and
nerves that have to pass through it. If anything
takes up extra room in the canal, things become
too tight and the nerve in the canal becomes
constricted or "pinched"

This pinching of the nerve (a medical condition

referred to officially as Nerve Entrapment) causes
numbness and tingling in the area of the hand that
the nerve travels to. The condition that results
when the Median Nerve is being pinched in The
Carpal Tunnel is commonly referred to as Carpal
Tunnel Syndrome or "CTS".

In actuality, the condition and its accompanying symptoms can be brought on by either a decrease in
the size of the carpal tunnel OR an enlarging of the tissues inside the tunnel.

Carpal Tunnel Syndrome has received a lot of attention in recent years because of suggestions that it
may be linked with occupations that require repeated use of the hands, such as typing on a computer
keyboard or doing assembly work. In reality, many people develop this condition regardless of the
type of work they do.

How Did I Get Carpal Tunnel Syndrome?

The most common cause of Carpal Tunnel Syndrome is inflammation of the tendons in the tunnel
which can normally be attributed to repetitive use of the hand and/or wrist.

Repetitive Strain Injuries (RSIs) can happen to anyone whose work calls for long periods of steady
hand movement, from musicians & dental hygienists to meat cutters & cashiers. RSIs tend to come
with work that demands repeated grasping, turning and twisting; they are especially likely if the work
requires repeated twisting or involves repetitive vibration, as in hammering nails or operating a power
tool. Stressful hand, arm and neck positions — whether from working at a desk, long-distance driving
or waiting on tables — only aggravate the potential for damage.

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A number of sports can bring on repetitive stress injuries: Rowing, golf, tennis, downhill skiing,
archery, competitive shooting and rock climbing are just a sampling of activities that stress the hand
and wrist joints. Injuries and ailments that cause swelling or compression of soft tissue on nerves,
such as sprains, leukemia, and rheumatoid arthritis, can lead to stress injuries.

Diabetes, thyroid problems, and other systemic disorders are also associated with discomfort from
stressed nerves, as is the fluid accumulation that sometimes accompanies pregnancy. Some
authorities believe that a pyridoxine (vitamin B6) deficiency can also induce the symptoms.

Fluid retention, a major contributor to CTS & RSI symptoms naturally occur with the usage of
contraceptive pills. Post Menstrual Syndrome (PMS) also causes fluid retention as do many other
medical conditions, all of which can result in Carpal Tunnel Syndrome symptoms.

What Are The Symptoms Of Carpal Tunnel Syndrome?

One of the first symptoms of CTS is gradual numbness in the areas supplied by the median nerve.
This is quickly followed by pain where the nerve gives sensation in the hand. The hand may begin to
feel like it's "asleep," especially in the early morning hours after a night's rest.

Pain may spread up the arm to the shoulder and even to the side of the neck. If the condition
progresses, the thenar muscles of the thumb can weaken and atrophy, causing the hand to be
clumsy when picking up a glass or cup. If the pressure keeps building in the carpal tunnel, the thenar
muscles may actually begin to shrink (atrophy).

Touching the pad of the thumb to the tips of the other

fingers becomes difficult, making it hard to grasp items
such as a steering wheel, newspaper, or telephone.

Symptoms In Summary

• A tingling or numb feeling in the hand and/or

fingers;

• Shooting pains in the wrist or forearm, and

sometimes extending to the shoulder, neck and
chest, or foot;

• Difficulty clenching the fist or grasping small

objects;

For many unfortunate sufferers, CTS has a pattern of flaring up through the night thereby making
sleep difficult. CTS symptoms can also be expected to arise frequently while performing the activity
that is the cause of the condition in the first place.

The Diagnosis Of Carpal Tunnel Syndrome

Physicians normally identify the condition by first obtaining a history of the problem, followed by a
thorough physical examination. Your description of the symptoms and the physical examination are
the most important parts in the diagnosis of CTS. Commonly, patients will complain first of waking in
the middle of the night with pain and a feeling that the whole hand is asleep.

Careful investigation usually shows that the little finger is unaffected. This can be a key piece of
information to make the diagnosis. If you awaken with your hand asleep, pinch your little finger to see
if it is numb also, and be sure to tell your doctor if it is or is not. Other complaints include numbness

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while using the hand for gripping activities, such as sweeping, hammering, or driving.

If your symptoms started after a traumatic wrist injury, X-rays may be needed to check for a fractured
bone.

If more information is needed to make the diagnosis, electrical studies of the nerves in the wrist may
be requested by your doctor. Several tests are available to see how well the median nerve is
functioning, including the nerve conduction velocity (NCV) test. This test measures how fast nerve
impulses move through the nerve.

Treatments For Relieving Carpal Tunnel Syndrome

• Conservative Treatment
Activities that are causing your symptoms need to be changed or stopped if at all possible. Avoid
repetitive hand motions, heavy grasping, holding onto vibrating tools, and positioning or working with
your wrist bent down and out. If you smoke, talk to your doctor about ways to help you quit. Lose
weight if you are overweight. Reduce your caffeine intake.

• Wrist Brace
A wrist brace will sometimes decrease the symptoms in the early stages of CTS. A brace keeps the
wrist in a resting position (not bent back nor bent down too far). When the wrist is in this position, the
carpal tunnel is as big as it can be--so the nerve has as much room as possible inside the carpal
tunnel. A brace can be especially helpful for easing the numbness and pain felt at night and can keep
your hand from curling under as you sleep. The wrist brace can also be worn during the day to calm
symptoms and rest the tissues in the carpal tunnel.

• Medication
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may also help control the swelling and reduce
symptoms of CTS. Common over-the-counter medications such as ibuprofen and aspirin are
sometimes recommended. In some studies, high doses of Vitamin B-6 (a key ingredient in CT
Cream™) have been shown to help in decreasing CTS symptoms.

Another attractive option for many sufferers, especially those who prefer to not ingest medication
orally, is the application of an appropriate and effective topical anti-inflammatory. CT Cream with
A.C.P. was specifically designed to reduce underlying inflammation and does so by taking advantage
of proven effective ingredients including Arnica, Choline and Pyridoxine & Vitamin B6.

• Physical Therapy
Your doctor may suggest that you work with a physical or occupational therapist. The main focus of
treatment is to reduce or eliminate the cause of pressure in the carpal tunnel. Your therapist may
check your workstation and the way you do your work tasks. Suggestions may be given about the use
of healthy body alignment and wrist positions, helpful exercises, and tips on how to prevent future
problems.

• Surgical Treatment
If all attempts to control your symptoms fail, surgery may be suggested to reduce the pressure on the
median nerve. Several different surgical procedures
have been designed to relieve pressure on the
median nerve. By releasing the pressure on the
nerve, the blood supply to the nerve improves, and
most people get relief of their symptoms.

However, if the nerve pressure has been going on a

long time, the nerve may have thickened and
scarred to the point that recovery after surgery is
much slower.

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The most common procedure is an open-incision technique, but some surgeons are using a newer
procedure called endoscopic carpal tunnel release. Using a smaller incision and a fiber-optic TV
camera, the doctor is able to see inside the carpal tunnel and release the transverse carpal ligament.

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