We hear about Carpal Tunnel Syndrome every day. The moment your hand falls asleep and you get the pins and needles in your fingers, somebody is bound to suggest that it is CTS. However, this is because most people do not have a clear understanding of what Carpal Tunnel Syndrome is. Understanding the physiognomy is important if you want to understand CTS. Carpals are the bones you feel when you touch your wrist. In the wrist is the carpal tunnel, which is enclosed by the carpals on three sides, and on the fourth side, by a transverse carpal ligament.
When you bend your wrist, to form a right angle, the carpal tunnel becomes much narrower. And when you stop to think about it, you will see that most activities, from playing the guitar to typing to having your lunch to pushing a swing, require your wrist to bend. Keeping it bent for prolonged periods of time – like when you type for a long time – compresses the median nerve, and causes the symptoms of CTS. If you do this repeatedly, you could be left with a clear cut case of Carpal Tunnel Syndrome.
Carpal tunnel syndrome (CTS), or median neuropathy at the wrist, is a medical condition in which the median nerve is compressed at the wrist, leading to paresthesias, numbness and muscle weakness in the hand. Night symptoms and waking up at night is a characteristic of established carpal tunnel syndrome. They can be managed effectively with night-time wrist splinting in most patients.
Many people who have carpal tunnel syndrome have gradually increasing symptoms over time. The first symptoms of CTS may appear when sleeping, and typically include numbness and paresthesias (a burning and tingling sensation) in the thumb, index, and middle fingers, although some patients may experience symptoms in the palm as well. These symptoms appear at night because people tend to bend their wrists when they sleep, which further compresses the carpal tunnel.
Most cases of CTS are idiopathic. CTS is sometimes associated with trauma, pregnancy, multiple myeloma, hypothyroidism, rheumatoid arthritis, and diabetes. There have been numerous scientific papers evaluating treatment efficacy in CTS. It is important to distinguish treatments that are supported in the scientific literature from those that are advocated by any particular device manufacturer or any other party with a vested financial interest. Generally accepted treatments, as described below, may include splinting or bracing, steroid injection, activity modification, physical or occupational therapy (controversial), medications, and surgical release of the transverse carpal ligament.
The newest of these is the Carpal therapist which is an electrically powered massaging device worn on the wrist and arm. The principle is that manipulative therapy, which is generally effective in alleviating symptoms of carpal tunnel syndrome, can be reproduced mechanically. Therefore, deep tissue massaging is produced by the device in a particular pattern in order to attenuate the tendons and to drain interstitial fluid from the inflamed carpal tunnel. This combined effect reduces the pressure inside the carpal tunnel and therefore alleviates the symptoms caused by median nerve compression.
Another active medical device is The Carpal Solution. It is composed of a series of adhesive tape strips, which, when applied in a certain orientation, reportedly initiates stretching and re-shaping of the wrist’s anatomy. The re-shaping produces less strain inside the carpal tunnel, and therefore relieves the pressure on the median nerve.
There is little evidence to support the use of physiotherapy or occupational therapy techniques for carpal tunnel syndrome. They seem to be oriented primarily towards non-specific activity related pain rather than the numbness of carpal tunnel syndrome. Occupational therapy offers ergonomic suggestions to prevent worsening of the symptoms. Occupational therapies facilitate hand function through remedial adaptive approaches. Using an over-the-counter anti-inflammatory such as aspirin, ibuprofen or naproxen can be effective as well for controlling symptoms. (Vitamin B12) has been helpful in some cases of CTS.
Release of the transverse carpal ligament is known as “carpal tunnel release” surgery. It is recommended when there is static (constant, not just intermittent) numbness, muscle weakness, or atrophy, and when night-splinting no longer controls intermittent symptoms. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and are likely to result in surgical treatment.
Dr Satnam Singh Chhabbra, Head Neuro & Spine Surgeon, Sir Gangaram Hospital, New Delhi