Carpal Tunnel Syndrome: Causes, Symptoms, Diagnosis, and Treatment
At J. Flowers Health Institute, we understand how carpal tunnel syndrome can negatively impact your quality of life. We’re here to help.
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What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is a common condition affecting millions worldwide. It is a medical condition that affects the hand and wrist.
Carpal tunnels are small passageways on the wrist’s palm side. It is composed of the carpal bones and the transverse carpal ligament, a strong band of connective tissue. Within this tunnel, the median nerve and the tendons that control finger movement pass through.
Inflammation or swelling of the carpal tunnel can pressurize the median nerve, leading to carpal tunnel syndrome.1
When Was CTS First Identified?
Carpal tunnel syndrome was first described in the mid-19th century, and the first surgery for the condition was performed in the 1930s.
A Closer Look at Carpal Tunnel Syndrome
Who is Most Likely to Develop Carpal Tunnel Syndrome?
Studies show that carpal tunnel syndrome primarily affects women and increases with age. It is also common in certain job types that take a lot of repetitive hand movements.2
However, research on who is more likely to develop carpal tunnel syndrome is still ongoing.
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Causes of Carpal Tunnel Syndrome
There are many contributing factors that can lead to carpal tunnel syndrome. Some of these factors are detailed below.3
Repetitive Hand and Wrist Movements
One of the primary mechanisms of CTS is repetitive hand and wrist movements, especially those involving forceful or prolonged flexion and extension of the wrist.
This can happen in various occupations and activities, such as:
- Using vibrating tools
- Assembling things
- Typing on a keyboard for extended periods
- Playing musical instruments
- Engaging in certain sports
Continuous use of the hands and wrists can lead to swelling and inflammation in the carpal tunnel. The increased pressure within the confined space compresses the median nerve, resulting in the characteristic symptoms of CTS.
Contributing Factors
While repetitive hand movements are a significant contributing factor, the following other factors can increase the risk of developing carpal tunnel syndrome:
Genetics
Some people may have a naturally smaller carpal tunnel, making them more susceptible to nerve compression even with less intense wrist use.
Underlying Health Conditions
Certain medical conditions, such as rheumatoid arthritis, diabetes, hypothyroidism, and obesity, can increase the risk of CTS.
These conditions may lead to:
- Inflammation
- Fluid retention
- Tissue changes contributing to nerve compression
Pregnancy
Hormonal changes during pregnancy can cause fluid retention and swelling, which may lead to CTS symptoms in some women. These symptoms often resolve after childbirth.
Obesity
Excess body weight can put extra pressure on the wrist and increase the risk of nerve compression.
Wrist Injuries
Fractures, dislocations, or other injuries to the wrist can cause structural changes, leading to nerve compression.
Inflammatory Conditions
Inflammation in the wrist joint, such as tenosynovitis, can affect the surrounding structures, including the carpal tunnel.
Risk Factors for Developing CTS
Below are some common risk factors for developing CTS.
Occupations With High CTS Risk
Certain occupations have a higher risk of developing carpal tunnel syndrome due to repetitive hand and wrist movements. These may include:
- Computer-related work: Typing on keyboards and using computer mice for extended periods.
- Manufacturing and assembly line work: Repeatedly using vibrating tools or performing fine motor tasks.
- Cashiers and supermarket workers: Constantly scanning items and handling products.
- Musicians: Playing instruments that require repetitive hand and finger movements.
- Hairdressers: Frequent use of scissors and hair dryers.
- Construction workers: Using vibrating power tools and performing repetitive motions.
The U.S. Department of Labor called carpal tunnel syndrome (CTS) the “chief occupational hazard of the 1990s,” disabling workers in epidemic proportions.
What is CTS? Causes and Overview
Gender and Age-Related Predispositions
CTS is more common in women than men, and the risk increases with age. The higher prevalence in women may be related to differences in hand and wrist anatomy and hormonal factors.
Moreover, as people age, the tissues in the carpal tunnel may become less flexible, making nerve compression more likely.
Women are three times more likely to develop carpal tunnel syndrome than men, possibly due to their narrower wrists.
Common Symptoms of Carpal Tunnel Syndrome
Below are some common symptoms of CTS.
Numbness and Tingling in the Hand and Fingers
The hallmark symptom of carpal tunnel syndrome is a sensation of numbness and tingling, known as paresthesia, in the:
- Thumb
- Index finger
- Middle finger
- Part of the ring finger
This sensation is often described as feeling like pins and needles or an electric shock. The numbness and tingling often occur on the palm side of the hand and may extend up the arm in more severe cases.
Pain and Discomfort in the Wrist and Forearm
Patients with CTS often experience pain and discomfort in the wrist and forearm. The pain may be dull, aching, or sharp and can vary in intensity.
It’s often felt in the palm and the thumb side of the hand, and it may radiate up the forearm. The pain is often more pronounced at night or upon waking up.
Weakness and Difficulty Gripping Objects
As carpal tunnel syndrome progresses, weakness in the affected hand may develop. Patients may find it challenging to grip objects or perform tasks that require fine motor skills, such as buttoning clothes or holding small items.
This weakness is due to the compression of the median nerve, which can impair the function of the muscles in the hand, particularly those controlling the thumb.
Recognizing the Progression of Symptoms
Carpal tunnel syndrome can start with mild and occasional symptoms and gradually progress over time if left untreated.
The progression of symptoms can be characterized by:
- Stage 1: This is the earliest stage of CTS. The symptoms are mild and may come and go.
- Stage 2: The symptoms become more constant and may interfere with daily activities.
- Stage 3: The symptoms are severe and may cause permanent damage to the nerve.
Differentiating CTS from Other Hand/Wrist Conditions
Several hand and wrist conditions can present symptoms similar to carpal tunnel syndrome. It’s essential to differentiate CTS from other conditions to ensure appropriate treatment.
Some conditions that may mimic CTS symptoms include:
De Quervain's Tenosynovitis
This condition is caused by inflammation of the tendons that move the thumb. De Quervain’s tenosynovitis symptoms include pain and swelling on the outside of the wrist, as well as difficulty moving the thumb.
Grasping, turning the wrist, or making a fist will aggravate the condition and may cause pain similar to carpal tunnel thumb pain. If left untreated, this condition can limit the range of motion in the wrist.
Women and people between 30 and 50 carry a higher risk of developing this condition.4
Arthritis
Arthritis can affect any joint in the body, including the joints in the hand and wrist. Symptoms of arthritis include:
- Pain
- Stiffness
- Swelling
- Decreased range of motion
Types of Arthritis
There are two main types of arthritis. Osteoarthritis involves the breakdown of the cartilage. Rheumatoid arthritis is an autoimmune disorder.
Arthritis does not often cause the characteristic numbness and tingling of CTS. But, people with arthritis are at a higher risk of developing CTS as the swelling in the tendons increases the pressure on the median nerve.5
Tendonitis
Tendonitis is inflammation of a tendon, a band of tissue connecting muscle to bone. Tendonitis can occur in any tendon in the hand or wrist, but it is most common in the tendons that move the thumb and fingers.
Symptoms of tendonitis include:
- Pain
- Swelling
- Stiffness in the affected area
Tendonitis typically does not cause numbness or tingling, distinguishing it from CTS.
Neuropathy
Neuropathy is the degeneration of nerves. It can occur in various medical conditions, such as:
- Diabetes
- Alcohol abuse
- Certain medications used in chemotherapy
Differentiating Neuropathy from CTS
Depending on the nerves affected, neuropathy can cause symptoms similar to CTS, including numbness, tingling, and pain in the hands and fingers.
Neuropathy can be difficult to distinguish from CTS as they both present similar symptoms. The nerve damage in other body parts, like the legs, can be a good indicator to rule out CTS. But, you may need a hand and wrist specialist to help you get the correct diagnosis.
Cervical Radiculopathy
Compression of nerves in the neck (cervical spine) can cause symptoms that radiate down the arm, mimicking CTS. It can be difficult to differentiate between the two because of the mimicking symptoms.
The main difference is where the pain originates. If it starts from the neck and runs down to the arm, it’s more likely a pinched nerve or cervical radiculopathy. A thorough evaluation by a healthcare professional can help distinguish between the two.
Carpal tunnel syndrome (CTS) is a common condition that affects about 50 out of every 1,000 people in the United States.
Diagnosing Carpal Tunnel Syndrome
Below are some of the approaches that help physicians diagnose CTS.
Medical History
The diagnosis of CTS begins with a comprehensive medical history conducted by a healthcare professional.
During the medical history, the doctor will ask about the patient’s:
- Symptoms
- Frequency
- Any factors that aggravate or reduce them
They will also ask about the patient’s occupation, hobbies, and any relevant medical conditions.
Physical Examination
The healthcare professional will assess the patient’s hand, wrist, and forearm in the physical examination.
They will look for signs of:
- Swelling
- Tenderness
- Muscle wasting in the hand
Our team will perform specific tests to evaluate the function and sensation of the median nerve. Some common physical tests that we may utilize at J. Flowers Health Institute include:
Tinel’s Sign
Tinel’s Sign is a clinical test where the doctor lightly taps over the carpal tunnel. If this elicits tingling or electric shock-like sensations in the hand, it may indicate carpal tunnel syndrome (CTS).
Wrist Flexion Test (or Phalen Test)
The Phalen test is performed by having the patient flex their wrists and touch the backs of their hands together. The patient is then asked to hold this position for 30-60 seconds.
If the patient experiences tingling, numbness, or weakness in the thumb, index, middle, and part of the ring finger, then the test is considered positive.
Electrodiagnostic Tests
Electrodiagnostic tests are valuable tools for diagnosing carpal tunnel syndrome and assessing its severity. Two primary electrodiagnostic tests used to diagnose CTS are nerve conduction studies (NCS) and electromyography (EMG).6
Nerve Conduction Studies (NCS)
This test measures how fast and how strong electrical signals travel through nerves. Small electrodes are placed on the skin over the median nerve at various points along its pathway. Nerves are stimulated with a mild electrical impulse.
Slower conduction velocities and reduced amplitudes of the nerve’s electrical signals may indicate nerve compression, suggesting CTS.
Electromyography (EMG)
EMG evaluates the electrical activity of muscles. It involves inserting fine needles into specific muscles to record their electrical signals at rest and during contraction.
EMG can identify abnormal muscle activity caused by nerve dysfunction, helping to confirm the diagnosis of CTS and rule out other diagnoses.
Imaging Techniques
Imaging techniques can be useful in diagnosing CTS, particularly when there is uncertainty or suspicion of other conditions.
Ultrasound
Ultrasound imaging can visualize the structures within the wrist, including the median nerve and surrounding tissues. It can help identify swelling or compression of the nerve and other anatomical abnormalities.
MRI
Magnetic resonance imaging uses powerful magnets and radio waves to create detailed images of the wrist and surrounding structures. MRI can provide valuable information about soft tissue structures, including the median nerve and potential compression causes.
X-Rays
X-rays do not help diagnose carpal tunnel syndrome, as swollen nerves don’t appear in an X-ray. But, some doctors may recommend having a wrist X-ray to rule out other conditions like arthritis and fractures.
A healthcare professional may use a combination of medical history, physical examination, electrodiagnostic tests, and imaging techniques to ensure an accurate diagnosis.
Identifying the specific condition accurately is vital for determining the appropriate treatment plan and managing symptoms effectively.
Prevention of Carpal Tunnel Syndrome
There is no surefire way to prevent carpal tunnel syndrome, but there are some things you can do to reduce your risk.
Take Breaks
If you do repetitive tasks with your hands, take breaks every 20-30 minutes to stretch and move your hands and wrists.
Avoid Repetitive Movements
If you can, avoid doing the same movements repeatedly. Repeated movements can stress your hands and wrists.
Use Proper Ergonomics
If you work at a computer, ensure your keyboard and mouse are comfortable and your wrists are in a neutral position.
Strengthen Your Hands and Wrists
Several exercises help strengthen your hands and wrists. Some of them include:
- Shaking your hands
- Opening and closing your fist in controlled movements
- Touching each fingertip to your thumb tips
- Squeezing a soft rubber ball for a few seconds
Strengthening your hands and wrists can help protect you from further injury.
Lose Weight
If you are overweight or obese, losing weight can help to reduce the pressure on your median nerve.
Quit Smoking
Smoking can damage the nerves in your hands and wrists. Quitting smoking can help to reduce your risk of CTS.
Additional Tips
Here are some additional tips to help prevent CTS:
Use a Wrist Splint: A wrist splint can help to keep your wrist in a neutral position and reduce the pressure on the median nerve.
Massage Your Hands and Wrists: Massage can help to improve circulation and reduce muscle tension in your hands and wrists.
Keep Your Hands Warm: Cold temperatures can constrict blood vessels and increase the risk of CTS. Keep your hands warm by wearing gloves or using a heating pad.
Drink Plenty of Fluids: Staying hydrated can help to reduce inflammation and improve circulation.
Get Enough Sleep: Sleep is essential for your health and well-being. Getting enough sleep can help to reduce stress and improve circulation.
Treatment Options for Carpal Tunnel Syndrome
There is no cure for carpal tunnel syndrome outside of surgery. Non-surgical interventions can help overcome pain and stiffness in the long run for mild to moderate symptoms.
If non-surgical interventions fail to help, opting for surgery gives the greatest chance for improvement, but recovery may take up to a year. Our team at J. Flowers Health Institute can help you determine which treatment option may be best for your carpal tunnel symptoms.
Non-Surgical Interventions:
Below are some non-surgical treatment options.
Rest and Activity Modification
Taking a break from activities that exacerbate CTS symptoms can provide relief and allow the inflamed tissues to heal.
Reducing repetitive hand movements and avoiding activities that strain the wrists excessively can help manage the condition.
Wrist Splints and Braces
Wearing a wrist splint or brace at night and during activities that trigger symptoms can help keep the wrist in a neutral position and reduce pressure on the median nerve. This can reduce numbness, tingling, and pain associated with CTS.
Physical Therapy
Working with a physical therapist can improve:
- Wrist flexibility
- Strength
- Range of motion
Therapists can teach specific exercises to stretch and strengthen the muscles and tendons in the hand and wrist, helping to reduce symptoms and prevent further progression of CTS.
Medications for Pain and Inflammation
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce pain and inflammation associated with carpal tunnel syndrome.
In some cases, corticosteroid injections may be prescribed to reduce inflammation and provide temporary relief.
7 Easy CTS At-Home Remedies
Surgical Treatments
Surgery may be considered if non-surgical interventions do not effectively reduce symptoms or if the condition is severe with significant nerve compression.
Indications for surgery include:
- Persistent or worsening symptoms
- Weakness in the hand grip
- Evidence of nerve damage confirmed through electrodiagnostic tests
Carpal tunnel release is the most common surgical procedure for CTS. There are two main approaches:
Open Release Surgery
In this traditional approach, a small incision is made in the palm. The transverse carpal ligament is cut to release pressure on the median nerve.
Endoscopic Release Surgery
This minimally invasive technique involves using a small camera and specialized instruments to cut the transverse carpal ligament through one or two small incisions.
Endoscopic surgery may result in a faster recovery and less scarring compared to open-release surgery.
Post-Surgery Recovery and Rehabilitation
After surgery, the hand may be bandaged and placed in a splint to protect the incision site. Physical therapy exercises will be gradually introduced to improve strength and flexibility. Most patients can resume light activities within a few weeks, while full recovery may take several months.
Short-term improvement in grip and pinch strength can be seen 2-3 months after surgery, but long-lasting relief from CTS symptoms is typically seen 6-12 months after surgery.
Living with Carpal Tunnel Syndrome
Living with chronic CTS can significantly impact a person’s quality of life, mental health, and well-being. Proper management and early intervention are crucial to minimizing these effects.
Coping Strategies
Coping strategies include:
- Avoiding activities that worsen symptoms
- Using assistive devices for certain tasks
- Applying cold packs to reduce inflammation
Modifying Daily Tasks
Modifying daily activities and work tasks can help reduce strain on the hands and wrists. This might involve:
- Using ergonomic tools and equipment
- Alternating between hands for tasks
- Incorporating regular breaks
Support Groups
Joining support groups or seeking information from reputable resources can offer valuable emotional support and guidance for individuals with carpal tunnel syndrome.
Get the Treatment You Need at J. Flower Health Institute
We understand carpal tunnel syndrome can be debilitating. J. Flower Health Institute can help you get the treatment you need to relieve your symptoms and get back to leading a fulfilling life.
Our team of experienced health practitioners is dedicated to providing you with the best possible care. We use the latest diagnostic tools to ensure we make the correct diagnosis, even when symptoms mimic other hand conditions.
What We Provide and How We Can Help
Our “Living MRI” is part of our comprehensive diagnostic evaluation program. Our team of experts will work with you to go over anything that may be contributing to your pain in order to accurately diagnose and treat your condition.
This may include:
- Physical examinations
- Medical evaluation
- Chronic pain evaluation
- Lifestyle assessment
- Comprehensive report and action plan
Reach Out and Begin Healing
If you are experiencing symptoms of CTS, don’t wait. Call J. Flower Health Institute today to schedule an appointment. We will work with you to find the right treatment for you.
Resources
- https://www.ninds.nih.gov/health-information/disorders/carpal-tunnel-syndrome#:~:text=Carpal%20tunnel%20syndrome%20(CTS)%20is,may%20become%20swollen%20and%20useless
- https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0685-0
- https://www.verywellhealth.com/carpal-tunnel-syndrome-causes-risk-factors-2549308#citation-6
- https://www.mayoclinic.org/diseases-conditions/de-quervain-tenosynovitis/symptoms-causes/syc-20371332
- https://www.healthline.com/health/arthritis-wrist#treatment
- https://www.jospt.org/doi/pdf/10.2519/jospt.2004.34.10.565
