What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome explained by San Antonio, Austin, Houston, Dallas Texas top pain doctors

Carpal Tunnel SyndromeCarpal tunnel syndrome is a musculoskeletal disorder that affects the upper-extremities. The exact cause of this condition is not well understood. Individuals with carpal tunnel pain report symptoms of muscle or joint weakness, tingling sensations, paresthesia (i.e., “pins and needles” sensation), numbness, burning sensations, pain, or discomfort, particularly in the wrist and one or all of the first three digits of the hand (i.e., thumb, index finger, and long finger). It is not uncommon, however, for individuals with carpal tunnel pain to describe that these sensations project from the wrist joint up through the forearm.

A recent study examining the prevalence and incidence of the condition has suggested that nearly 8% of industry workers suffer from carpal tunnel syndrome. This study also reported that incidences of carpal tunnel occurred more frequently among women and was higher with increasing age.

Carpal tunnel syndrome is reported to be the most expensive musculoskeletal disorder affecting the upper-extremities. Estimates of annual medical care costs in the U.S. associated with the condition exceed $2 million, particularly due to surgical release. Carpal tunnel pain is also associated with high non-medical costs. It has been estimated that symptoms of carpal tunnel are to blame for an average of 27 days annually in missed work.

Causes Of Carpal Tunnel Syndrome 

Symptoms of carpal tunnel syndrome are believed to emerge as the result of median entrapment neuropathy. Located within the palmar side of the wrists, there is a narrow canal comprised of bone and protective ligaments, which is known as the carpal tunnel. This canal acts as a protective passageway for several different tendons and one nerve—the median nerve. This nerve provides motor control to the index finger, middle finger, and thumb. It also functions as the sensory nerve for the palm-side of the index finger, middle finger, and thumb.

The precise mechanism underlying the development of carpal tunnel is not fully defined; however, the source of the symptoms associated with this condition are believed to be the result of compression to the median nerve within the carpal tunnel. Factors that contribute to the development of symptoms can include genetic predisposition. In other words, some individuals may be genetically wired to have smaller carpal passageways. This is believed to place that person at an increased risk for developing carpal tunnel. Further, as individuals get older, they are more at risk for having difficulty with regard to symptoms of carpal tunnel pain. Interestingly, higher rates of carpal tunnel syndrome have been found among populations of women.

Certain medical conditions are related to higher incidences of carpal tunnel syndrome. These include rheumatoid arthritis, dysregulated pituitary gland, and hypothyroidism. Additionally, individuals with a higher body mass index or who are obese are more likely to suffer from carpal tunnel.

Greater incidences of carpal tunnel have also been reported during pregnancy. The exact mechanism that accounts for this is not known, but some have suggested that the higher rate of fluid retention during pregnancy may explain the augmented risk. This increase in fluid within the body may place extra pressure on the median nerve inside the narrow passageway of the carpal tunnel.

A number of environmental factors have been documented in relation to carpal tunnel syndrome. The most common factor identified in risk for developing carpal tunnel is an individual’s line of work. Industry workers who regularly use machinery with excess vibration or work on an assembly line can be exposed to irritation and inflammation of the soft tissue within the wrist, leading to compression of the median nerve.

Individuals who must regularly engage in forceful exertion at work run the risk of damage or irritation to the median nerve. Further, acute or chronic trauma to the wrist or forearm can also contribute to symptoms of carpal tunnel.

Treatments For Carpal Tunnel Syndrome

The primary aim in treating carpal tunnel syndrome is providing the patient with relief from their symptoms of pain and discomfort. For individuals whose symptoms of carpal tunnel syndrome are milder and that have not begun to significantly impair their daily functioning, conservative at-home interventions may be very beneficial in providing relief. More specifically, patients with carpal tunnel syndrome may be encouraged to wear a supportive brace or splint on their wrist. This provides temporary protection to the wrist to prevent further injury, as well as restricts joint movement to allow the area to heal.

Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, are also commonly recommended to treat carpal tunnel pain. These oral analgesics provide relief from symptoms of pain and discomfort by reducing inflammation in the area.

It is not uncommon for physicians to recommend oral diuretics to treat symptoms of carpal tunnel syndrome. These decrease fluid retention and thereby reduce any swelling and inflammation in the body.

For individuals with chronic difficulty with carpal tunnel pain or whose symptoms have not responded to previously attempted treatment, corticosteroid injections may be considered. In a survivor analysis examining the effects of corticosteroid injections, it was found that 33% of carpal tunnel patients who were receiving corticosteroid injections denied receiving any further treatment at a two-year follow-up.

Finally, a small portion of carpal tunnel patients will require a more invasive procedure, as their carpal tunnel pain is unremitting despite numerous treatment attempts. For these individuals, surgery is regarded as the last resort; however, undergoing this procedure to release the pressure placed upon the median nerve may successfully alleviate their symptoms. There are two surgery options available, including open release and endoscopic. The open release procedure is more invasive and requires a longer recovery period. The endoscopic procedure is less invasive, can be done under local anesthetic, and is associated with shorter recovery times. Both of these procedures have been shown to provide carpal tunnel patients with relief from pain and discomfort associated with the condition.

Conclusion

Carpal tunnel syndrome is a musculoskeletal disorder that is caused by median entrapment neuropathy. Symptoms of carpal tunnel include muscle or joint weakness, tingling sensations, paresthesia (i.e., “pins and needles” sensation), numbness of the area, burning sensations, pain, or discomfort, particularly in one or all of the first three digits of the hand (i.e., thumb, index finger, and long finger). Both genetic and environmental factors have been identified as contributing to the risk for developing carpal tunnel syndrome. There are many treatment options available for relieving the symptoms of carpal tunnel. These can include over-the-counter pain relievers, corticosteroid injections, or even surgical release. It is recommended that individuals speak with their physician or health care provider about the risks and benefits associated with treating carpal tunnel pain.

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References

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  3. Fernandez-de-Las-Penas C, Cleland JA, Plaza-Manzano G, Ortega-Santiago R, De-la-Llave-Rincon AI, Martinez-Perez A, Arroyo-Morales M. Clinical, physical, and neurophysiological impairments associated with decreased function in women with carpal tunnel syndrome. J Orthop Sports Phys Ther. Jul 2013; [Epub ahead of print].
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  6. Soltani AM, Allan BJ, Best MJ, Mir HS, Panthanki ZJ. A systematic review of the literature on the outcomes of treatment for recurrent and persistent carpal tunnel syndrome. Plast Reconstr Surg. 2013;132(1):114-121.