Carpal Tunnel Syndrome (CTS)
Carpal tunnel syndrome(CTS) is a common condition that causes pain, numbness, tingling, and weakness in the hand and wrist. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.This nerve provides sensation to the thumb, index, and middle fingers, and to half of the ring finger. The small finger (the “pinky”) is typically not affected.
The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and sides of the tunnel are formed by small wrist bones called carpal bones.
The roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament. Because these boundaries are very rigid, the carpal tunnel has little capacity to stretch or increase in size.
The median nerve is one of the main nerves in the hand. It originates as a group of nerve roots in the neck; these roots then come together to form a single nerve in the arm.
The median nerve travels down the upper arm, across the elbow, and into the forearm, then passes through the carpal tunnel at the wrist on its way to the hand and fingers. It separates into several smaller nerves along the way, particularly once it reaches the palm. These nerves allow for feeling in the thumb, index finger, middle finger, and half of the ring finger (the thumb side).The median nerve also controls the muscles around the base of the thumb.
The nine tendons that bend the fingers and thumb also travel through the carpal tunnel with the nerve. These tendons are called flexor tendons because they flex the fingers and thumb.
The symptoms of carpal tunnel syndrome include the following:
• Numbness or tingling in your hand and fingers, especially the thumb, index, and middle fingers.
• Pain in your wrist, palm, or forearm. You may shake or rub your hand to get relief.
• More numbness or pain at night than during the day. It may be so bad that it wakes you up.
• 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
The pain in your carpal tunnel is due to excess pressure in your wrist and on the median nerve. Inflammation can cause swelling. The most common cause of this inflammation is an underlying medical condition that causes swelling in the wrist, and sometimes obstructed blood flow.
Some of the most frequent conditions linked with carpal tunnel syndrome are:
• thyroid dysfunction
• fluid retention from pregnancy or menopause
• high blood pressure
• autoimmune disorders such as rheumatoid arthritis
• fractures or trauma to the wrist
Risk Factors –
A number of factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase the risk of irritation or damage to the median nerve. These include:
• Anatomic factors.
A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.
Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men.
• Nerve-damaging conditions.
Some chronic illnesses, such as diabetes, increase the risk of nerve damage, including damage to the median nerve.
• Inflammatory conditions.
Rheumatoid arthritis and other conditions that have an inflammatory component can affect the lining around the tendons in the wrist and put pressure on the median nerve.
Some studies have shown a link between carpal tunnel syndrome and the use of anastrozole (Arimidex), a drug used to treat breast cancer.
Being obese is a risk factor for carpal tunnel syndrome.
• Body fluid changes.
Fluid retention may increase the pressure within the carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally gets better on its own after pregnancy.
• Other medical conditions.
Certain conditions, such as menopause, thyroid disorders, kidney failure and lymphedema, may increase the chances of carpal tunnel syndrome.
• Workplace factors.
Working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage, especially if the work is done in a cold environment.
Untreated carpal tunnel syndrome can lead to –
• permanent nerve damage
• loss of hand function
Before a doctor can recommend a course of treatment, they will perform a thorough evaluation of the condition, including a medical history, physical examination and often diagnostic testing.
These diagnostic studies may include:
• Tinel’s sign
In this test, the physician taps over the median nerve at the wrist to see if it produces a tingling sensation in the fingers.
• Wrist flexion test (or Phalen test)
In this test, the patient rests his or her elbows on a table and allows the wrist to fall forward freely. Individuals with carpal tunnel syndrome will experience numbness and tingling in the fingers within 60 seconds. The more quickly symptoms appear, the more severe the carpal tunnel syndrome.
To look at the bones of the wrist to determine if any abnormalities may contribute to CTS.
To evaluate the median nerve and assess for any mass lesions that may be present in the carpal tunnel.
• Electromyogram and Nerve Conduction Study (EMG/NCS)
To show how the nerves and muscles are working together. They measure the electrical impulse along nerve roots, peripheral nerves and muscle tissues.
Carpal tunnel syndrome can be treated in two ways: non-surgically or with surgery.
▪︎ Non-surgical treatments
Non-surgical treatments are usually tried first. Treatment begins by:
• Wearing a wrist splint at night.
• Taking nonsteroidal anti-inflammatory drugs, such as ibuprofen.
• Cortisone injections.
Other treatments focus on ways to change your environment to decrease symptoms. This is often seen in the workplace, where you can make modifications to help with carpal tunnel. These changes might include:
• Raising or lowering your chair.
• Moving your computer keyboard.
• Changing your hand/wrist position while doing activities.
• Using recommended splints, exercises and heat treatments from a hand therapist.
▪︎ Surgical treatments
Surgery is recommended when carpal tunnel syndrome does not respond to non-surgical treatments or has already become severe. The goal of surgery is to increase the size of the tunnel in order to decrease the pressure on the nerves and tendons that pass through the space. This is done by cutting (releasing) the ligament that covers the carpal tunnel at the base of the palm. This ligament is called the transverse carpal ligament.
Ayurvedic Therapies –
Ayurvedic treatment for CTS involves treatments like such as
• Navara Kizhi etc. to reduce numbness and pain.
Effective herbs –
Carpal tunnel syndrome can be difficult to prevent. The condition can be caused by so many different activities in a person’s daily life that prevention can be challenging. Workstation changes—proper seating, hand and wrist placement—can help decrease some factors that can lead to carpal tunnel syndrome.
Other preventative methods include:
• Sleeping with your wrists held straight.
• Keeping your wrists straight when using tools.
• Avoiding flexing (curling) and extending your wrists repeatedly.
• Decreasing repetitive/strong grasping with the wrist in a flexed position.
• Taking frequent rest breaks from repetitive activities.
• Performing conditioning and stretching exercises before and after activities.
• Monitoring and properly treating medical conditions linked to carpal tunnel syndrome.
Treating your carpal tunnel syndrome early with physical therapy and lifestyle changes can lead to significant long-term improvement, and eliminate symptoms.
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