Carpel Tunnel Syndrome (CTS)
Carpel Tunnel Syndrome is a condition that causes pain, numbness, and tingling of the fingers and hand. Occasionally, the discomfort extends up the arm to the shoulder. The basic problem that causes CTS is a pinched nerve in the wrist.
On the palmer side of the wrist, a group of bones, called carpel bones, are attached together by ligaments forming an open space and this space is called the carpel tunnel. A number of tendons from the muscles in the forearm, pass through the carpel tunnel to the fingers, allowing the forearm muscles to control the activities of the fingers. Also, a nerve from the spinal cord, called the median nerve, passes from the neck and down the arm, then through the carpel tunnel, providing innervation to the thumb, index, middle, and the thumb side of the ring finger. The median nerve also innervates the muscle at the base of the thumb (the thenar eminence).
CTS occurs when the tunnel narrows, usually from swelling and/or inflammation. This narrowing of the canal compresses the median nerve. Initially, this can cause a dull ache in the wrist that can progress to symptoms in the hand and fingers that are innervated by the median nerve (as described above). At times, the discomfort can radiate up the forearm and into the shoulder, tracking the course of the median nerve back toward the spinal cord. The most common symptoms include a dull ache in the wrist, with occasional sharp, shooting pains and numbness and tingling of the fingers, known as paresthesia. Chronic persistent nerve compression can result in grip strength weakness and clumsiness of the hand causing such difficulties as holding small objects, turning door knobs or keys, or buttoning a shirt.
Symptoms are worsened by any activity that requires repeated flexion and extension of the wrist. Symptoms are common at night because during sleep, the wrist can be flexed or extended for prolonged time periods, increasing nerve compression. Also problematic, is prolonged elevation of the arm(s), such as gripping a steering wheel while driving, holding up a book while reading, or prolonged key boarding. Use of vibratory tools can also cause or aggravate the problem. Simply shaking the hand(s), can provide some relief of the symptoms.
Common conditions that can cause CTS from swelling and inflammation of the carpel tunnel include the following:
· Wrist trauma – Can result in tendonitis of the tendons that pass through the tunnel or damage to the carpel bones that form the canal.
· Obesity – Adipose tissue accumulates around the wrist.
· Generalized edema – Fluid retention of any cause. This is more common in women and CTS is 3 times more common in women than in men.
· Arthritis of the wrist – Rheumatoid and osteoarthritis. CTS is more common in the former.
· Diabetes Mellitus – Unknown mechanism.
· Pregnancy – Thought to be due to fluid retention and hormonal changes.
· Hypothyroidism – Deficiency of thyroid hormone. This usually is associated with CTS in both hands.
A diagnosis of CTS can usually be made by a competent physician using the history of symptoms and a physical exam. If there is uncertainty after this evaluation, the diagnosis can be made by electromyography and nerve conduction testing.
The initial mainstay of treatment that can be diagnostic as well as therapeutic, is wearing a simple “Cock-Up Wrist Splint”, particularly at night while sleeping. This splint has a strip of light metal on its palmar side which keeps the wrist slightly extended removing pressure from the nerve. If this is beneficial, a diagnosis of CTS is confirmed. If this fails, corticosteroid injections into the carpel tunnel may be beneficial as well as physical therapy. If all conservative measures fail, there is a relatively simple surgical procedure that can alleviate the problem by widening the carpel tunnel opening.
Dr. Tippett is the founder of Comprehensive Quality Healthcare Providers, Inc. a concierge internal medicine practice located at 1210 Commerce Dr. Suite 106 Greensboro, Ga. 30642. He can be reached at 706-510-3659. Visit his webpage at www.drtippett.com