Carpal Tunnel Syndrom Pain in Wrist and Hand

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a painful disorder of the wrist and hand.
The carpal tunnel is a narrow tunnel formed by the bones and other tissues of your wrist. This tunnel protects your median nerve. The median nerve helps you move your thumbs and the first 3 fingers on each hand.
Carpal tunnel syndrome occurs when other tissues in the carpal tunnel (such as ligaments and tendons) get swollen or inflamed and press against the median nerve. That pressure can make part of your hand hurt or feel numb.

Symptoms of carpal tunnel syndrome

• Numbness or tingling in your hand and fingers, especially the thumb, index and middle fingers.
• Pain in your wrist, palm or forearm.
• More numbness or pain at night than during the day. The pain may be so bad it wakes you up. You may shake or rub your hand to get relief.
• Pain that increases when you use your hand or wrist more.
• Trouble gripping objects, such as a doorknob or the steering wheel of a car.
• Weakness in your thumb.

What causes carpal tunnel syndrome?

Doing the same hand movements over and over can lead to carpal tunnel syndrome. It’s most common in people whose jobs require pinching or gripping with the wrist held bent. People at risk include people who use computers, carpenters, grocery checkers, assembly-line workers, meat packers, musicians and mechanics. Hobbies such as gardening, needlework, golfing and canoeing can sometimes bring on the symptoms.
Women are more likely to develop carpal tunnel syndrome than men. It also tends to be hereditary (which means it runs in families).
Carpal tunnel syndrome may also be caused by an injury to the wrist, such as a fracture. Or it may be caused by a disease such as diabetes, rheumatoid arthritis or thyroid disease. Carpal tunnel syndrome is also common during the last few months of pregnancy.

Who is at risk of developing carpal tunnel syndrome?

Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body’s nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome usually occurs only in adults.

The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work – manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. A 2001 study by the Mayo Clinic found heavy computer use (up to 7 hours a day) did not increase a person’s risk of developing carpal tunnel syndrome.

During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker.

How is carpal tunnel syndrome diagnosed?

Your doctor will probably ask you about your symptoms. He or she may examine you and ask you how you use your hands. Your doctor may also do these tests:

• Your doctor may tap the inside of your wrist. You may feel pain or a sensation that feels like an electric shock.
• Your doctor may ask you to bend your wrist down for 1 minute to see if this causes symptoms.
• Your doctor may have you get a nerve conduction test or an electromyography (EMG) test to see whether the nerves and muscles in your arm and hand show the typical effects of carpal tunnel syndrome.

How is carpal tunnel syndrome treated?

Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor’s direction. Underlying causes such as diabetes or arthritis should be treated first. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling.

Non-surgical treatments

Drugs – In special circumstances, various drugs can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Orally administered diuretics (“water pills”) can decrease swelling. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Corticosterioids should not be taken without a doctor’s prescription.) Additionally, some studies show that vitamin B⁶ (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.

Exercise – Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.

Alternative therapies – Acupuncture and chiropractic

Surgery

Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require surgery on both hands. The following are types of carpal tunnel release surgery:

Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.

Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½” each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. One-portal endoscopic surgery for carpal tunnel syndrome is also available.

Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.

Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.

How can carpal tunnel syndrome be prevented?

 At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the worker’s wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.

Many products you can buy — such as wrist rests — are supposed to ease symptoms of carpal tunnel syndrome. No one has proven that these products really prevent wrist problems. Some people may have less pain and numbness after using these products, but other people may have increased pain and numbness.

Things that may help prevent carpal tunnel syndrome

• Lose weight if you’re overweight.
• Get treatment for any disease you have that may cause carpal tunnel syndrome.
• If you do the same tasks over and over with your hands, try not to bend, extend or twist your hands for long periods of time.
• Don’t work with your arms too close or too far from your body.
• Don’t rest your wrists on hard surfaces for long periods of time.
• Switch hands during work tasks.
• Make sure the tools you use aren’t too big for your hands.
• Take regular breaks from repeated hand movements to give your hands and wrists time to rest.
• Don’t sit or stand in the same position all day.

Tips on relieving carpal tunnel syndrome

• Prop up your arm with pillows when you lie down.
• Avoid overusing the affected hand.
• Find a new way to use your hand by using a different tool.
• Try to use the unaffected hand more often.
• Avoid holding your wrists in a downward bent position for long periods of time.

Resources: Carpal Tunnel Syndrome at Familydoctor.org

http://familydoctor.org/online/famdocen/home/common/pain/disorders/023.html

The Carpal Tunnel Syndrome Facts Sheet

http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm#toc