Carpal Tunnel Syndrome

All About Carpal Tunnel

Carpal Tunnel Anatomy

The wrist bones (bottom) and the transverse carpal ligament (top) create an opening in the wrist through which the median nerve and the flexor tendons pass into the hand.

median nerve anatomy

What does the median nerve do?

The median nerve provides both sensory and motor functions to the hands, conducting sensory information to the central nervous system and movement commands back to the muscles. The median nerve is also responsible for the most critical muscles in the thumb. It is these thenar muscles that allow the thumb to be opposable, giving it the ability to press against the other fingers.

What are the flexor tendons?

The flexor tendons connect muscle groups in the arm to the bones in the hand and move the fingers and hand. Covered in tenosynovium, a lubricating sheath, the flexor tendons are able to slide over each other.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is the result of an impairment to the median nerve caused by cumulative trauma through use of the muscles and tendons in and around the carpal tunnel.

carpal tunnel syndrome

CTS can begin with a simple case of muscle overuse in the forearm area. The muscles in the forearm make all hand movements possible. If these forearm muscles are overused and tighten up, the tendons that attach these muscles to the bones in the hand become irritated and inflamed.

 

When the flexor tendons in the carpal tunnel become irritated or inflamed, the tenosynovium (the lubricated sheath protecting the tendons) swells, pinching the median nerve against the transverse carpal ligament. The damage to the median nerve generates the symptoms associated with CTS.

carpal tunnel median nerve

CTS can result from problems apparently unrelated to the wrist or forearm. The double crush phenomenon results from damage or pinching of the median nerve at the neck or shoulder area. Nerve compression can result from poor posture or tight muscles in the neck or shoulders. The compression pulls the joints out of working alignment, irritating delicate support tissue and thereby putting pressure on the nerve pathway.

Are There Degrees Of CTS?

Some doctors have classified CTS into three levels, based upon degree of suffering as well as method of treatment.
clearclear
Level 1:
Tingling and soreness are reduced by rest or massage. No nerve damage is detected.
Level 2:
Symptoms intensify while orthopedic and neurological tests indicate nerve damage.
Level 3:
With severe symptoms, the pain is constant.  Doctors recommend total immobilization of the wrist or surgery to relieve the stress on the median nerve.
What are common symptoms?
Sensory
Motor
numbness
loss of hand strength
tingling
weakness of thumb
burning
reduced muscle development in thumbs
coldness
difficulty holding or pinching items
pain
stiffness

Treatment for Carpal Tunnel Syndrome

The best approach for dealing with Carpal Tunnel Syndrome is to visit your doctor. Though surgery is the best known form of treatment, a number of options exist, based on your level of CTS and on personal preference.

Should I take medication?

You feel pain as a result of the body’s production of prostaglandin to trigger pain transmission through the central nervous system. Over-the-counter drugs like aspirin not only block the production of prostaglandin, but reduce swelling. However, prolonged use of aspirin combined with neglecting to receive medical attention, may cause more damage to your body.

Some doctors prescribe NSAIDs (non-steroidal anti-inflammatory drugs) for treatment of Carpal Tunnel Syndrome, but their use, effectiveness, and cost vary from case to case.

Injections of the steroid Cortisone provide a similar, temporary relief of the symptoms, as do other medications, yet only 1 of 5 patients treated with medication remains ache free in a year’s time.

Will I have to undergo surgery?

There are currently two forms of surgery performed for the extreme cases of Carpal Tunnel Syndrome where non-invasive treatments have failed.

1. Through an incision in the wrist, typically two inches long, Open Carpal Tunnel Release severs the transverse ligament to relieve pressure on the median nerve.

2. Recently, by using an arthroscope (surgical camera) and cutting tool through a tube into the carpal tunnel, Endoscopic Carpal Tunnel Release removes the tissue pressuring the median nerve by slicing it off. This new “closed” procedure leaves a scar roughly a half-inch wide. Results and percentage rates of success from such surgical procedures vary widely.

Click “Carpal Tunnel Surgery To Reduce Pain” for more information.

Other possible treatments for CTS
Carpal Tunnel Ergonomics
Yoga for Carpal Tunnel

Preventing Carpal Tunnel Syndrome

What is Ergonomics?

Ergonomics is the relation between the body and the machine it operates. When it comes to CTS, the relation between computer and user is a pivotal element to your health.

Using correct posture can play a large role in preventing CTS. Be sure to sit up straight and keep your arms at a ninety degree angle to the desk.

Carpal Tunnel Ergonomics

Take breaks from activities that stress the flexor tendons, and utilize this time to relax as much of your body as you can. Remember, your health is a culmination of factors and stresses that must be regulated.


Should you experience symptoms of CTS during any activity, evaluate how you are using your wrists, as well as the rest of your posture. Repetitive hyperextension or hyperflexion of the wrist generates such stress on the tendons surrounding the median nerve that CTS can develop rapidly, with little warning.

Do not wait for the pain to go away on its own. Take immediate action to modify your actions to prevent further damage. Consult a physician as soon as possible after the onset of pain; you may be suffering from a number of conditions outside of CTS.

What kind of diet can help prevent CTS?

Some claim that B6 is a wonder vitamin in the prevention of CTS, but a well balanced diet, including B6, is a better preventative step. Your body’s overall well-being is critical in maintaining its ability to heal and cope with trauma.

Click “Options For Carpal Tunnel Syndrome” for more information.

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