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Carpal Tunnel Syndrome Information

  • Carpal tunnel syndrome (CTS) is a medical condition in which the median nerve is compressed at the wrist causing symptoms like tingling, numbness, night time wakening, pain, coldness, and sometimes weakness in parts of the hand. CTS is more common in women than it is in men, and has a peak incidence around age 50 (though it can occur in any adult). The lifetime risk for CTS is around 10% of the adult population...
  • The first symptoms of CTS usually appear when trying to sleep. Symptoms range from paresthesia (a burning, tingling numbness in the fingers, especially of the thumb and index and middle fingers) to difficulty gripping and making a fist. Inability to firmly grasp and dropping things is common. If left untreated the symptoms can progress, and increasing pain intensity can further restrict hand functionality. In the early stages of CTS, individuals often mistakenly blame the tingling numbness on their sleeping position, thinking their hands have had restricted circulation and are simply "falling asleep".

    It is important to note that unless numbness is one of the predominant symptoms, it is unlikely the symptoms are primarily caused by carpal tunnel syndrome. In effect, pain of any type, location, or severity with the absence of significant numbness, is not likely to fall under this diagnosis.

    Carpal tunnel syndrome is known as a "hidden disability" because people can do some things with their hands and appear to have normal hand function. However, despite these appearances, those afflicted often live with severely restricted hand activity due to the pain.

    The relationship between work and CTS is very controversial because in many locations workers injured at work are entitled to time off and compensation. Many cases of carpal tunnel syndrome are provoked by repetitive grasping and manipulating activities. The exposure can be cumulative. Activities may be work-related or related to other activities (e.g. home improvement chores.) Symptoms are commonly exacerbated by forceful and repetitive use of the hand and wrists in industrial occupations, including jack hammer operators, meat packers, computer users and musicians. In the U.S., for instance, carpal tunnel syndrome is the biggest single contributing factor to lost time at work. Carpal tunnel syndrome results in billions of dollars of workers compensation claims every year.

    Rigid immobilizing braces and wrist splints can help some people, but they can be limiting and uncomfortable to wear. Over several weeks braces and splints often result in hand and forearm muscle atrophy. For this reason braces should not be worn continuously for more than a few days at a time. Instead many health professionals suggest that, for best results, one wear them at night and, if possible, during the activity primarily causing stress on the wrists.

    Physiotherapy offers several ways to treat and control carpal tunnel syndrome. Manual treatment that includes deep friction massage can help manage the swelling that is a factor in nerve compression. This is combined with manual stretches to the tendons to the fingers and wrist. Another modality of treatment is ultrasonic therapy, which in some cases may work as a treatment by itself, but is better when used in combination with other physiotherapy treatments. There are numerous other techniques offered by competent occupational and physical therapists (O.T. or P.T.) that can aid in the control of carpal tunnel symptoms. Therapy can be very effective in helping to calm flares of carpal tunnel symptoms. The key is also to maintain the lessons learned in therapy in a home program. Therapy in this way can control symptoms. While therapy is useful for short or long term management of "mild to moderate" carpal tunnel symptoms, one must note that it controls the process, but does not cure it. Thus, if nothing else changes, and therapy is discontinued, then symtoms will usually ultimately return. Finally, physical therapy tends to be innefective in even temporarily controlling symptoms of "moderate to severe" severity.

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