What are the other Names for this Condition? (Also known as/Synonyms)

• CTS (Carpal Tunnel Syndrome)
• Median Nerve Dysfunction due to Carpal Tunnel Syndrome
• Median Nerve Entrapment

What is Carpal Tunnel Syndrome? (Definition/Background Information)

• The carpal tunnel is a small rigid passageway surrounded by bones and ligaments at the base of the hand, in the area of the wrist. This passageway protects a key central nerve within the hand (called the median nerve) and 9 tendons, which allow the fingers to stretch and grab (flexion and extension)
• Carpal Tunnel Syndrome (CTS) is a gradual, progressive, and painful condition that affects the hand and arm, resulting in muscle weakness. It occurs when the tissues that surround the tendons within the wrist swell, putting excessive pressure on the median nerve
• Overall, women are 3 times more likely to develop CTS than men, especially after menopause
• Both nonsurgical and surgical methods are available to treat the condition. The prognosis of Carpal Tunnel Syndrome is usually excellent with appropriate early intervention

Who gets Carpal Tunnel Syndrome? (Age and Sex Distribution)

• Carpal Tunnel Syndrome may occur in individuals of all ages, races, ethnic groups, and genders
• Overall, individuals between the ages of 30-60 years, have the highest rate of occurrence
• Women (especially after menopause) are 3 times more likely to develop CTS, than men

What are the Risk Factors for Carpal Tunnel Syndrome? (Predisposing Factors)

Common risk factors associated with Carpal Tunnel Syndrome include:

• Any sport that requires repetitive overuse of the hand or wrist joint, such as with baseball or tennis
• Women have a higher incidence of CTS, particularly after menopause
• Chronic inflammatory disorders (such as rheumatoid arthritis)
• High blood glucose levels that result from, either an insulin secretion deficiency (diabetes type II), or an insulin resistance (diabetes type I) in the body
• Abnormal pressure on the carpal tunnel, due to excessive body weight (obesity)
• Certain occupations that require repetitive overuse of the wrist, such as carpentry, painting; individuals, who do excessive typing
• Studies have indicated that Carpal Tunnel Syndrome may have a genetic component
• Hormonal or metabolic changes, due to pregnancy or thyroid imbalance, can increase an individual’s risk of developing the condition
• A rare disorder that involves the hardening and thickening of the skin and connective tissues, called scleroderma, causes an increased pressure on the median nerve, due to formation of fibrous tissue around the nerve
• Individuals working outdoors in cold environments have an increased chance of developing CTS

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Carpal Tunnel Syndrome? (Etiology)

Currently, the underlying cause of Carpal Tunnel Syndrome is unknown. However, several contributing factors, proposed by scientists in the development of CTS include:

• Individuals, who participate in sports (especially professional athletes) that require repetitive overuse of the hand or wrist joints, such as with baseball or tennis
• Hormonal or metabolic changes associated with menopause, pregnancy, and thyroid imbalance
• Chronic inflammatory disorders (such as rheumatoid arthritis)
• High blood glucose levels, either due to insulin secretion deficiency (diabetes type II), or due to insulin resistance (diabetes type I) in the body

What are the Signs and Symptoms of Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is a condition that usually starts slowly with a minor pain in the wrist, which may extend to the hand or forearm. With time, the pain progressively increases.

Other signs and symptoms of Carpal Tunnel Syndrome include:

• Radiating pain within the hand
• Tingling sensation, noticeable numbness of the hand
• Weakness in strength of the hand muscles

How is Carpal Tunnel Syndrome Diagnosed?

Diagnostic methods that a physician may use to help diagnose Carpal Tunnel Syndrome include:

• Physical examination: A thorough physical examination is important in determining, if an individual has Carpal Tunnel Syndrome.
  • During this exam, a physician may test the fingers for sensation and the strength of the hand muscles, which can be affected by CTS
  • Individuals may be asked the list of activities that one may be performing, which cause repetitive motions around the wrist joint
  • Individuals are also expected to provide an explanation of the circumstances that led up to the injury. In addition to this, a complete medical history will aid in arriving at a definitive diagnosis
• Blood tests, such as fasting blood glucose, thyroid function test, tests for rheumatoid arthritis, may be performed
• X-ray of wrist: X-rays use radiation in order to produce images of your wrist. It can also help the physician rule out other possible causes for wrist discomfort, such as arthritis, or a fracture
• Electromyography (EMG): An EMG shows the electrical activity of the muscle, during rest and during muscle contraction. Examining the electrical activity may help a physician identify any injury, to the median nerve within the wrist
• Nerve conduction velocity (NCV) study: Nerve conduction velocity study shows the speed at which electrical signals move through a nerve. Slowing of nerve conduction speed may indicate median nerve damage

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Carpal Tunnel Syndrome?

If Carpal Tunnel Syndrome is properly treated, a high percentage of individuals usually do not experience any serious complications. However, a common complication associated with CTS includes a permanent injury to the median nerve. This can result in:

• Permanent loss of strength of the hand muscles
• Permanent loss of sensation in the hand region

How is Carpal Tunnel Syndrome Treated?

The treatment measures for Carpal Tunnel Syndrome include nonsurgical and surgical methods.

Nonsurgical treatment measures include:

• Any activity that aggravates the wrist condition should be avoided. The physician may advise the individual to refrain from participating in any physical activities, till the pain or symptoms get better
• Application of ice/cold pack to the wrist, to reduce pain and swelling
• Complete immobilization of the wrist with a cast may be required, to restrict movement
• Non-steroidal anti-inflammatory oral medications, such as indomethacin and naproxen, may be used to treat Carpal Tunnel Syndrome. These medications can help decrease the pain and swelling

Surgical treatment measures include:

• Endoscopic carpal tunnel release: It is a minimally invasive surgical procedure that allows a physician to examine certain structures within the wrist, such as the transverse carpal ligament, using an orthopedic device (called endoscope). During this procedure, the transverse carpal ligament is cut, which decreases any abnormal pressure on the median nerve, thereby reducing the signs and symptoms that the individual is experiencing

How can Carpal Tunnel Syndrome be Prevented?

Currently, there are no definitive methods available to prevent Carpal Tunnel Syndrome. However, certain measures that may be helpful in preventing abnormal pressure on the median nerve include:

• Take regular breaks by occasionally bending or stretching the hands or wrists. Individuals, who do office work (such as typing) are advised to alternate between tasks
• Avoid any sports or physical activities that require repetitive overuse of the hands or wrists
• Proper treatment of type I diabetes and type II diabetes can help prevent CTS, in such individuals
• Proper treatment of underlying conditions, such as scleroderma and rheumatoid arthritis
• Estrogen replacement therapy can decrease the incidence of CTS after menopause, in women
• Improper posture of the upper body, such as hunching and stooping, may increase the pressure around the neck and shoulder joint. This causes an increased pressure in the neck region. Since, the median nerve travels from the neck to the fingers, an increased pressure may result in signs and symptoms associated with CTS. Hence, maintaining a proper upper body posture may help in preventing the development of Carpal Tunnel Syndrome
• Maintaining a healthy body weight can help reduce abnormal pressure on the wrist joints
• A high percentage of hand-related pain and stiffness develop, when the temperature in the work place is cold. Wearing proper attire to help keep the hands and wrist warm, can help in decreasing the signs and symptoms of CTS
• Many individuals tend to use unwarranted and excessive force to perform simple tasks involving the hands, when the situation may demand a much less force. A relaxed grip can limit the amount of stress applied to the carpal tunnel, in such cases

What is the Prognosis of Carpal Tunnel Syndrome? (Outcomes/Resolutions)

• Carpal Tunnel Syndrome can range in severity, from being a minor condition to a serious and disabling condition
• The long-term prognosis of CTS is usually good in a majority of the individuals. However, over 50% of all individuals, require a surgical correction of the condition
• If detected and treated early, signs and symptoms of CTS can be controlled; in many instances, they may completely disappear
• If left untreated, severe cases of the disorder may result in permanent muscle strength and sensation loss, leading to a decreased ability of the individual, to participate in any athletic, professional, or recreational activity

Additional and Relevant Useful Information for Carpal Tunnel Syndrome:

The following article link will help you understand a surgical treatment method for Carpal Tunnel Syndrome.

http://www.dovemed.com/common-procedures/procedures-surgical/carpal-tunnel-syndrome-repair/