Introduction
Probably you know someone who suffers from carpal tunnel syndrome (often abbreviated as CTS). This musculoskeletal condition affects 8 million people each year, based upon statistics gathered by the Bureau of Labor and Statistics and the National Institute for Occupational Safety and Health (NIOSH). Furthermore, carpal tunnel surgery is the second most common surgery for musculoskeletal conditions.
Carpal tunnel syndrome can result when there is pressure on the median nerve that runs through the carpal tunnel of the wrist. A closer look at the anatomy of the hand and wrist can explain why this small part of the body creates such pain and discomfort for so many individuals.
The Wrist and Hand
First, we will take a look at the anatomy of the hand and wrist in order to see what is going on anatomically in a proper functioning carpal tunnel. Then we will see what changes that create a medical problem within the carpal tunnel.
Anatomy
Small wrist bones, the carpals, actually form the floor and the sides of the carpal tunnel. This narrow passage in the wrist is approximately one inch wide. The top of the tunnel is created by the transverse carpal ligament. Inside the tunnel formed by these physical components is where the median nerve and flexor tendons reside. These tendons (there are 9 of them), as well as the median nerve, are directly involved in allowing the fingers and thumb to bend. The space between the carpal tunnel and the tendons is very close: so close that inflammation in that area can create serious pain. (1)
The median nerve itself is a vital nerve serving the operation of the hand. The nerve runs down into the hand, and in the other direction, goes up the forearm. It is this nerve that allows for feeling in the thumb, index, middle and ring fingers.
Immediate Cause of Carpal Tunnel Syndrome
Since the space inside the carpal tunnel is so small and somewhat unforgiving in flexibility, the development of inflammation within that space can quickly cause a problem to develop. Inflammation results when there is an acute accident (such as a car accident where the wrist is sprained) or when repetitive movement continually aggravates the wrist. Repetitive movement, like when a data entry operator spends hours per day typing information into a computer, could eventually lead to the development of inflammation in the carpal tunnel.
Soft tissue, called the synovium, cushions those 9 flexor tendons. Synovium serves to lubricate the tendons, which allows for the easy movement of the fingers. When those tissues swell, the carpal tunnel narrows. This puts pressure on the median nerve. When the soft tissue of the synovium swells up, the pressure on the nerve will eventually cause pain, numbness, lack of feeling, tingling, pins and needles sensation, and weakness in the affected hand. (2)
Let’s now take a closer look at the various symptoms that can reveal that there is an issue within the carpal tunnel.
Symptoms of Carpal Tunnel Syndrome
Carpal tunnel issues often reveal themselves at night, when the hand, fingers, and wrist are in a relaxed state. The first symptom that may be felt is a tendency for fingers to feel numb. By morning, the numbness may extend into the hands or even all the way into the shoulder.
Additional symptoms that may be felt are burning sensations in the fingers and/or hand, or tingling sensations in the same areas.
To sum up, the first signs of carpal tunnel syndrome include:
- Numbness
- Burning sensations
- Tingling sensations
Although these symptoms are aggravating, they may not rise to the level of causing someone to seek out medical attention. Often a person’s life or occupation has to be disrupted by pain or weakness before someone realizes they are suffering from a condition that may require medical intervention. Unfortunately, the damage from carpal tunnel syndrome may have reached a more severe level by the time these additional symptoms begin to appear and disrupt the individual’s life.
If the conditions that caused carpal tunnel syndrome to develop are not alleviated, over time the median nerve will become more and more irritated. It can lose some of its function, which slows down the speed of the nerve impulses running to the fingers. The fingers will then begin to lose feeling. This causes a loss in the ability of the fingers to perform normal daily tasks. There is also a corresponding decrease in strength. Pain and cramping in the hand and fingers will begin to be a problem. Grip strength and the ability to use the thumb to pinch and pick up objects will decrease. (3)
As the carpal tunnel syndrome grows worse, the following additional symptoms may be experienced:
- Fingers lose feeling
- Grip strength wanes
- Weakness
- Pain
- Cramping
- Thumb cannot pinch objects
- May begin dropping things
When symptoms escalate to this point, it is time to seek medical treatment. By now, the symptoms are appearing at all times of the day or night. Routine activities, like driving a vehicle or turning the pages of a book may be painful. Typing on a computer keyboard may be impossible. If allowed to continue without treatment, carpal tunnel syndrome can cause permanent loss of strength and/or sensation. (4)
Now that we can recognize some of the common symptoms of carpal tunnel syndrome, let’s examine how this debilitating condition can develop.
Causes of CTS
The underlying causes of carpal tunnel syndrome often include some sort of repetitive motion that routinely places pressure on components of the carpal tunnel. In some instances, however, a severe accident can create damage to part of the carpal tunnel system, leading to the development of carpal tunnel syndrome. Let’s look at these 2 causes of CTS. Following that, we will look at some additional risk factors that may enhance an individual’s likelihood to develop carpal tunnel syndrome.
Repetitive Motion
Carpal tunnel syndrome is usually caused when an individual is engaged in an activity involving a repetitive motion of the hand and fingers. Often it is connected with the individual’s occupation. Some examples of repetitive motion tasks that may result in carpal tunnel syndrome include data entry, sewing, and assembly line work.
Here are some other occupations where repetitive motion may result in carpal tunnel problems. Please note: this is not an exhaustive list.
- Playing musical instrument such as guitar, piano, keyboard
- Computer work
- Mechanic
- Painter
- Cashier
- Repeat usage of vibrating tools
Injury
Another cause of carpal tunnel syndrome is injury. Being involved in a vehicle accident that results in broken bones in the wrist, hand or fingers may lead to carpal tunnel issues. Even a badly-sprained wrist could create carpal tunnel syndrome. (5)
Since repetitive motion or a severe injury can result in the development of carpal tunnel syndrome, an individual who suspects they may have carpal tunnel syndrome should ponder whether or not they are engaged in some sort of regular activity that involves repetitive motion.
Let’s also take a look at some of the risk factors that can make it more likely that carpal tunnel syndrome may develop.
Additional Risk Factors
Heredity. Heredity can increase the likelihood that someone will develop this medical condition. Some individuals, due to genetics, have a smaller than normal carpal tunnel. This anatomic feature will restrict the space that exists for the median nerve to operate. This risk factor may become obvious over time, if every woman in several different generations of a family develops carpal tunnel syndrome.
Improper Hand or Wrist Position. If an individual engages in an activity that requires extreme flexion of the hand and wrist, over time that person may develop swelling in the synovium, leading to an increase in pressure on the median nerve.
Pregnancy. Whereas this is a temporary medical condition, changes in hormones during pregnancy can cause the individual to experience swelling which could lead to carpal tunnel symptoms.
Certain medical conditions. Several medical conditions that cause inflammation to develop, like diabetes and rheumatoid arthritis, are often a risk factor for the development of carpal tunnel syndrome. (6)
Conditions That Resemble CTS
There are several other medical conditions that resemble carpal tunnel syndrome. These include cubital tunnel syndrome, cervical nerve impingement, type II diabetes, and peripheral neuropathy. With these particular medical conditions, there are some symptoms that are similar to carpal tunnel syndrome. Consultation with a medical professional will allow the appropriate diagnosis to be reached. Let’s take a quick look at these 4 conditions in order to see what distinguishes them from carpal tunnel syndrome.
Cubital Tunnel Syndrome
Cubital tunnel syndrome is also referred to as ulnar neuropathy. This medical condition has symptoms akin to carpal tunnel syndrome. Pain, tingling, weakness in the muscles of the hands, and numbness are all found with CTS. The differentiating factor here is the cause of the medical condition. Cubital tunnel syndrome is caused when pressure on the ulnar nerve, which is commonly called one’s ‘funny bone’. The pressure compresses the nerve, causing the symptoms that are felt in the hand and fingers.
Some signs of cubital tunnel syndrome that are different from CTS include:
- Visible muscle wasting in the hand
- Visible muscle wasting in the hand
- Weakness in the little finger
- Hand becomes deformed so that it looks like a claw
Cubital tunnel syndrome is often caused by repetitively leaning one’s elbow on a hard surface. It can also result when someone maintains a bent elbow for sustained periods of time. (7)
Cervical Nerve Impingement
Cervical nerve impingement, also called cervical radiculopathy, results when a nerve root near the cervical vertebrae in the spine is compressed. When the nerve root sustains damage, it creates a loss of sensation along the path the nerve takes from the spine to the hand. (8)
Symptoms are the main thing that differentiates cervical nerve impingement from carpal tunnel syndrome. An individual suffering from cervical nerve impingement may experience pain that spreads into areas such as the shoulders, upper back, chest and arm. Although they may experience numbness in the fingers or weakness in the hands, these other painful regions are very different from what an individual with carpal tunnel may experience.
Type II Diabetes
Medical researchers are beginning to find connections between the development of carpal tunnel syndrome and Type II diabetes. It is believed that the high blood sugar levels a diabetic experiences actually cause damage to tendons located in the carpal tunnel. The tendons end up inflamed, so inflammation develops. It is now believed that a diagnosis of carpal tunnel syndrome may be an indicator that an individual has type II diabetes. (9)
Peripheral Neuropathy
Certain individuals who have Type II diabetes may develop peripheral neuropathy. This can occur in the hands as well as the feet. Some of the symptoms of this are numbness, pain, cramping sensations in the hand, and instances when the individual is unable to hold onto objects. Peripheral neuropathy is caused by nerve damage that results over time from high levels of blood glucose. (10)
These are only a few of the medical conditions that contain symptoms that are similar to that of someone experiencing carpal tunnel syndrome. The best way to determine which medical condition is causing the painful symptoms that result is to consult a medical professional so that appropriate intervention can begin as soon as possible.
Let’s look at some of the diagnostic tests that one can expect once a medical professional is consulted.
Diagnosis of CTS
Once an individual experiences enough discomfort, or their job has become difficult to complete due to weakness in the hand, a medical professional may be consulted. The medical professional has a great many diagnostic tools available to reach a diagnosis. Here is a general layout of what a patient may expect to happen at the medical visit.
Medical and Occupational History
One of the first things a physician will do is obtain a thorough medical history. As mentioned above, there are hereditary conditions that increase the risk factor for the development of carpal tunnel syndrome.
Since the physician is looking for risk factors for a possible diagnosis of carpal tunnel syndrome, there will be a discussion of one’s occupation and extracurricular activities to see if they involve repetitive motion.
Physical Exam
The physician will then conduct a physical exam. This will involve checking out the fingers, hands, wrist, arm, shoulder all the way into the neck. The doctor will be looking for areas of swelling, warmth, pain and loss of feeling. The physician will also check the strength in the hand’s grip.
Now it is time to do specific diagnostic tests to see if the median nerve has been compromised in some fashion.
Tinel’s Sign
The doctor will use a reflex hammer to tap on the patient’s wrist. If the patient feels a tingling in the fingers, or something akin to an electric shock, the test is positive. It is more likely than not that the median nerve has been compromised. Carpal tunnel syndrome may be the culprit.
Phalen’s Maneuver
Another test the physician will probably do is a wrist flexion test. The patient is directed to press the backs of the hands together, pointing down. If fingers are tingling or becoming numb after 2 minutes, it is likely that there is pressure on the median nerve and it is quite possible carpal tunnel syndrome has developed. (11)
Other Diagnostic Tests
If the physician wants to do further testing before reaching a diagnosis, there are some additional diagnostic tests that can be done. These include nerve conduction studies, electromyography, and ultrasound.
A nerve conduction study can actually measure the median nerve’s ability to pass a signal down the nerve. Electromyography involves the use of a specially-designed recording technique that can determine the amount of damage done to a nerve by detecting the electrical activity of muscle fibers. Finally, an ultrasound is a quick way to determine if the median nerve is abnormal in size. (12)
Treatment
Those who suffer from Carpal Tunnel Syndrome often want to know what treatments are available. Treatments should always start with more conservative treatment. Most cases of CTS can be resolved through the use of conservative treatment without the need for surgery.
Conservative treatment can include steps to reduce stress on the wrist, decrease inflammation and pain, improve flexibility and open the space for the median nerve to move through the carpal tunnel.
One common treatment is the use of rehabilitation with cold laser therapy. This combination of treatment is typically scheduled over several weeks and monitored for its effectiveness. Laser therapy is often very helpful for carpal tunnel syndome and it enables the provider to work directly into the specific area of problem.
Belden Village of Chiropractic & Wellness Center offers effective treatment of carpal tunnel syndrome including the use of cold laser therapy.
Schedule a consultation to determine if you are a candidate for Carpal Tunnel Syndrome.
Conclusion
If you are experiencing symptoms of carpal tunnel syndrome, by now you realize that this medical condition can result in permanent damage if intervening medical treatment is not sought in a timely fashion. Carpal tunnel syndrome is something that millions of people live with every day. Perhaps it is time for you to seek medical attention to determine how best to proceed in dealing with this medical condition shared by millions of people around the globe.
References:
- https://orthoinfo.aaos.org/en/diseases–conditions/carpal-tunnel-syndrome/
- https://orthoinfo.aaos.org/en/diseases–conditions/carpal-tunnel-syndrome/
- https://www.webmd.com/pain-management/carpal-tunnel/carpal-tunnel-syndrome#1
- http://www.assh.org/handcare/hand-arm-conditions/carpal-tunnel/
- https://www.nolo.com/legal-encyclopedia/can-i-make-carpal-tunnel-injury-claim.html
- https://orthoinfo.aaos.org/en/diseases–conditions/carpal-tunnel-syndrome/
- https://www.webmd.com/pain-management/qa/when-are-you-more-likely-to-get-cubital-tunnel-syndrome
- https://www.webmd.com/pain-management/qa/what-is-cervical-radiculopathy
- https://www.healthline.com/diabetesmine/the-411-on-carpal-tunnel-syndrome-diabetes#1
- https://www.healthline.com/health/diabetic-peripheral-neuropathy-symptoms#self-care
- https://www.webmd.com/pain-management/carpal-tunnel/carpal-tunnel-diagnosis#2
- https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet
