Since the 1930s, the general population of the United States has been plagued by Carpal Tunnel Syndrome (CTS) with over 8 million new cases documented each year. A common occupational hazard, it causes employers to pay over $7.4 billion in Worker’s Compensation and can create major upheaval in life with only 23% of people being able to return to their previous jobs. With the majority of Americans either heading back to the office or spending most of their time at their home-office computer, CTS remains a possibility for many. So, what is CTS? How can we avoid it? And, if afflicted, what are the treatment options?
The Carpal Tunnel
Surrounded by tendons, ligaments and bones, this narrow passageway leads from the wrist to the hand. The carpal bones make up the bottom and sides of the tunnel, while the carpal ligament covers the top (palm-side). The tunnel allows passage of the median nerve and nine tendons that travel from muscles in the forearm to bones in the hand allowing us to move our fingers and thumbs. The median nerve provides feeling to the palm side of the thumb and index, middle and part of the ring fingers (not the little finger).
CTS begins when the median nerve becomes pressed or squeezed at the wrist due to thickening from the lining of irritated tendons or other swelling, which causes frequent numbness or tingling in the fingers and thumbs. Grasping objects or performing manual tasks is difficult and, if left untreated, the muscles at the base of the thumb will waste away, further inhibiting dexterity and strength. People with severe CTS often cannot determine between hot and cold by touch and can suffer burns without feeling it.
Cause and Symptoms
No single, underlying cause for CTS is known; rather, a combination of factors is usually the culprit. Wrist trauma or injury, an overactive pituitary gland, an underactive thyroid, rheumatoid arthritis, diabetes, or a cyst or tumor located in the tunnel can play a role in CTS development. The most common cause remains the repeated use of vibrating hand tools, assembly line work and often, repetitive movements. Gender also plays a large role as women are three times more likely to develop CTS than men.
The main symptom of CTS is numbness and/or tingling in the fingers, which later becomes pain. Sufferers often claim that their digits feel swollen even though no physical swelling is evident. Symptoms often first appear at night and can cause the afflicted to wake from sleep. During the day, symptoms can take the form of grip weakness, trouble handling small objects, or increased difficulty writing or typing. As the syndrome worsens, there can be difficulty holding onto objects and performing simple tasks such as buttoning a shirt or turning a steering wheel.
Treatment
After diagnosis, there are a few options for treatment of CTS, depending on its severity. In hopes of relieving the issues causing undue pressure upon the median nerve, non-surgical options are typically tried first. They are:
- Splinting – wearing a wrist splint at night or during the day helps keep the wrist straight and the carpal tunnel open. The goal is to reduce pressure on the median nerve by giving it as much room as possible, especially during sleep.
- Changing Daily Routine – Identifying and altering daily tasks that can worsen CTS symptoms can help relieve pain and pressure in the long run. Something as simple as taking a break from the task, when possible, can go a long way toward recovery.
- Over-the-Counter & Prescription Drugs – In certain circumstances, common anti-inflammatories
such as aspirin or ibuprofen may provide short-term relief of the symptoms but, as the condition worsens, they are not enough and stronger corticosteroids such as prednisone are prescribed. For persons experiencing mild symptoms, lidocaine is injected directly into the wrist to relieve pressure on the median nerve. - Yoga – Improving flexibility and muscle fitness has been shown to relieve pain and increase grip strength. Yoga, in particular, has shown positive results in people suffering from mild CTS.
If the condition continues to worsen, surgery may be a person’s only relief. CTS surgery is the second most common surgery in the U.S. with over 230,000 procedures performed annually. Generally, surgery involves severing the carpal ligament around the wrist to relieve pressure on the median nerve.
There are two types of CTS surgery:
- Open Release – A two-inch incision is made in the wrist to sever the carpal ligament and enlarge the carpal tunnel.
- Endoscopic – The surgeon makes one or two incisions about a half-inch each, inserts a camera attached to a tube to observe the carpal tunnel via monitor, and then severs the carpal ligament with a small instrument inserted through the tube. This procedure offers faster recovery and lesspost-operational discomfort, but has a higher risk of complications and possible need for further surgery.
Those undergoing surgery may experience infection, stiffness or pain at the incision site and a decrease in grip strength, which improves over time. While healing, work activity will have to be modified and some may need to change jobs after recovery. Recurrence of the condition following surgery is rare.
Avoidance
Although common, CTS can be avoided by making simple changes to how we work and play. Here are eight easy ways to keep CTS at bay.
- Try a softer touch. When working on certain tasks, we often use a little more “oomph” than needed. Maybe we pound the keyboard when typing, use a little extra torque when turning a screw, or go too hard for too long. Remember: You are a caveman no longer. We have evolved. Go easy.
- Take a break. Everyone needs to take some time to relax once in a while. If possible, take a ten-minute break every hour to stretch and rest your hands. Take a few deep breaths. Then, get back to it.
- Stretch often. Does Stretch Armstrong get CTS? The answer is NO. He’s as loose as a long-neck goose and you should be, too. While stretching, do not neglect your wrists. The internet offers a bevy of simple stretches to keep them supple – give them a try.
- Stay neutral. Avoid bending your wrists. Make sure your workspace is set up in such a way that your wrists remain even with your desktop, or at least in line with your hands as much as possible if working on a shop floor.
- Switch it up. If your daily routine or job allows it, mix up your tasks to avoid repetitive motion for long periods.
- Maintain good posture. Straighten your body, straighten your wrists.
- Stay warm. Colder temperatures can cause greater pain and stiffness. Keeping your hands warm or wearing fingerless gloves can help relieve pressure.
- Visit an occupational therapist. If all else fails, get professional help. An occupational therapist can help you alter your day-to-day plan to avoid CTS and other work-related maladies.
References
Cleveland Clinic. (2021). Carpal tunnel syndrome. Clevelandclinic.org. Retrieved from my.clevelandclinic.org/health/diseases/4005-carpal-tunnel-syndrome
Harvard Medical School. (2014). Can you avoid carpal tunnel syndrome? Harvard.edu. Retrieved from health.harvard.edu/pain/can-you-avoid-carpal-tunnel-syndrome
National Institute of Neurological Disorders and Stroke. (2021). Carpal tunnel syndrome fact sheet. NIH.gov. Retrieved from ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet
Orthopedic Center of Arlington. (2021). 11 astounding carpal tunnel statistics. Orthoarlington.com. Retrieved from orthoarlington.com/contents/patient-info/conditions-procedures/11-astounding-carpal-tunnel-statistics
Wheeler, T. (2021). 9 things you can do to prevent carpal tunnel syndrome. WebMD.Com. Retrieved from webmd.com/pain-management/carpal-tunnel/how-can-i-prevent-carpal-tunnel-syndrome
A common occupational hazard, CTS causes employers to pay over $7.4 billion in Worker’s Compensation.
