At first symptoms of Carpal Tunnel Syndrome
are slight and usually infrequent. This is usually caused by excessive use of
the hand for specific tasks. Once the hand and wrist are rested there may be no
symptoms at all. As the use of the hand/wrist increases with repetitive tasks
the symptoms and Carpal Tunnel Syndrome worsen. The pressure on the nerve
increases and the individual can experience any number of the above symptoms at
a greater and greater frequency.
Causes
Like many Skeletomuscular Disorders Carpal
Tunnel Syndrome has a variety of causes. It is often the result of a combination
of factors. Anything that causes swelling on the Tendons or produces repeated
pressure on the Median Nerve can lead to Carpal Tunnel Syndrome or make it worse
if the condition already exists. Among these factors are:
Genetic Predisposition:
There is a select amount of people who are more likely to get Carpal Tunnel
Syndrome than others are. Doctors do not know why or how to establish which kind
of person you are. From person to person there are differences in the amount of
lubrication of the Flexor Tendons of the wrist. The less lubrication of those
Tendons the more likely you are to get Carpal Tunnel Syndrome.
Injuries And Trauma: A blow
to the wrist or lower arm can make Tendons swell. A break in one of the wrist
bones as well can encourage the onset of Carpal Tunnel Syndrome.
Health And Lifestyle:
People who suffer with Thyroid Diseases, Amyloidosis, Rheumatoid Arthritis, and
Diabetes are more prone to others to develop Carpal Tunnel Syndrome. People who
experience Hormonal changes relating to Pregnancy, Menopause and the use of
Birth Control Pills also are more prone to Carpal Tunnel Syndrome. Job stress
also has been linked to an increased likelihood of Carpal Tunnel Syndrome. As
well as, there is more frequency of Carpal Tunnel Syndrome in Alcoholics.
Repetitive Motion: This is
the MOST common cause of Carpal Tunnel Syndrome. It has been mostly attributed
to the workplace. But, Let also not count out hobbies as well. Repetitive
motions are found throughout the workplace. Everything from typing on your
Keyboard to using vibrating hand tools or instruments of some kind. Everything
from typing at work to knitting at home has some repetitive motion. When you
flex your hand or fingers the Flexor Tendons rub against the walls of the Carpal
Tunnel. If you allow your hand time to recover this rubbing will, most likely,
not lead to some kind of irritation. The amount of recovery time needed varies
from person to person. From seconds to hours. When you do not let your hand or
wrist recover from the flexing or the work it was doing and start the flexing
and working all over again that's when Carpal Tunnel can originate.
Anatomy
The Median Nerve (Figure
1) runs into the hand to supply the sensation for the Thumb, Index Finger Long
Finger and a Good Portion of the Ring Finger. It is also responsible for the
Musculature of the Thumb called the Thenar Muscles. These muscles (Figure 2) are
also effected by Carpal Tunnel Syndrome in the fact that weakness can occur.
This weakness results in the inability to bring the thumb into position with the
other fingers and eventually hinders the grasp of the individual sufferer. As
well as, The everyday use of the hand as compared to everyday use before Carpal
Tunnel Syndrome set in.
As time goes on and Carpal Tunnel Syndrome
progresses use of the hand and the thumb becomes more difficult. Tasks that
require thumb or hand strength or minute precise movements get more and more
fatiguing as the progression of Carpal Tunnel Syndrome continues. As Carpal
Tunnel Syndrome advances numbness and pain is a pronounced result. The pain can
radiate up the arm to the shoulder and sometimes as far as the neck.
Additionally numbness usually strikes in the hands and sometimes the wrist. On a
daily occurrence. (See Figure 3)
Most individuals wake to find that their
first three digits on their hands have a "Pins And Needles" feeling in them.
They "Tingle". They don't have normal feeling or reaction for a slight time
period.
Looking at the cross section of the wrist
(Figure 4)
we see the Flexor Tendons, In white, With the Median Nerve, represented by the
orange circle, laying underneath the Transverse Carpal Ligament. The Flexor
Tendons allow us to move our hands and digits such as when we type and grasp
something. These tendons are covered by a slippery material called Tenosynovium.
The Tenosynovium allows the tendons to glide and move against each other as the
fingers and hand moves. The constant repetitive motion involved in the beginning
process of Carpal Tunnel Syndrome causes the tendons to become irritated and
inflamed. This can result in swelling and thickening of the Tenosynovium. As the
tendons swell and thicken they start to place pressure on the Carpal Tunnel
itself. (See Figure 5)
The Carpal Tunnel itself cannot increase in
size with respect of the swelling and inflammation of the tendons. The Carpal
Tunnel is made up of bones and ligaments. They are not able to stretch. So as
the swelling increases there is an increase of pressure on the Median Nerve
against the Transverse Carpal Ligament. (The White Sheath In The Figure 5)
Slowly over time, Enough pressure takes it's toll on the Median Nerve and it can
no longer function normally. At that time the pain and the numbness become
pronounced. Carpal Tunnel Syndrome is then apparent to the individual.
Prevention
There are many steps available to take that
lower your chances of developing Carpal Tunnel Syndrome. There are even more
devices that are available that do the same. Most of the preventative techniques
center around the configuration of the work environment you are in.
Wrist Angle: If your
keyboard is positioned properly your wrists should be able to rest comfortably
on the table in front of it. Some keyboards have risers in them that makes them
stand up above the table top. Because of the height of the keyboard you then
have to bend your wrists to hit all of the keys. Such wrist bending motion is a
common cause of Carpal Tunnel Syndrome. If you have to bend your wrists it has
been recommended that you get a Wrist Rest. These inexpensive accessories can
save your wrists in the long run.
Elbow Angles: With your
hands resting comfortably on your keyboard and your upper arms vertical note the
angle between your Forearm and your upper arm. If its elevating a slight amount
upwards raise your seat. If your forearm and lower arm are pointing a slight
amount downwards lower your seat. Take into mind that your legs also should be
at a 90 degree angle as compared to your lower arms. If you find yourself in the
correct position with your legs but not your wrist's. Get a Wrist Rest.
Waist And Back Angles:
You may not think it but waist angle has as much to DO with Carpal Tunnel
Syndrome as wrist angle does. The Skeletal graphic, At left, Is a good example
of proper waist and back positioning. With your legs being at a 90 Degree angle
your arms too should be at a 90 Degree angle. If your arms and your legs are not
at a 90 Degree angle there should be some repositioning so that both arms and
legs fall within the 90 Degrees. Your arms and legs need to be level with each
other. If your legs are too high that means you have to raise your chair.
One thing we CANNOT stress
enough is proper posture. The graphic at right represents poor posture. Buy
curving the back not only are you putting stress on the back but also along the
wrists, waist, upper shoulder, neck, and other areas. This kind of posture will
most defiantly lead to a loss of 90 Degree angles in the waist, back and wrists.
It will also lead to an increased probability of Carpal Tunnel Syndrome
occurring. there is nothing that provides better support to your back, waist and
wrist than sitting straight up with your legs and lower arms both at 90 Degree
angles to each other.
Feet:
Now that we have established that your back, your legs and your lower arms
should always be at a 90 Degree angle to each other, your feet should rest
comfortably flat on the floor in front of you. If you have a 90 Degree angle on
your legs and on your lower arms and your feet do not reach the floor
comfortably there are ergonomic products out that will correct any small
problems you run into.
Ergonomics: Proper seating
and position is crucial to good ergonomics. The height of your seat and the
position of your backrest should be adjustable. Arm rests on chairs are helpful.
You must maintain proper posture at all times while being comfortable. The best
and easiest way to do this is to find the best products that both meet your
comfort level and provide the best prevention against Carpal Tunnel Syndrome.
Diagnosis
Diagnosis is to be done by a Doctor. If you
have some of the symptoms of early Carpal Tunnel Syndrome get to a Doctor before
it is aggravated additionally.The most painful cases of Carpal Tunnel Syndrome
are the cases that have gone undetected or untreated for a long period of time.
Carpal Tunnel Syndrome can be caught in it's early stages and most of the pain
and ALL of the disability can be avoided. At the first symptom of Carpal Tunnel
Syndrome (See Symptoms) get to a Doctor.
Once at the Doctors a full history of the
problem will be taken. This will then be followed by a Physical Examination.
your description of the problems and symptoms you are having, as well as, the
Physical Examination, are the most important parts of the Examination. If
additional information is needed Electrical Studies of the nerves of the wrist
will be done. Including the tests that follow.
Tinel's Sign Test: Your Doctor will gently
tap on the front of your wrist. If this causes a tingling or a "Pins And
Needles" feeling in your hand or forearm you may have Carpal Tunnel Syndrome.
Phalen's Sign Test: Your Doctor will check
the motion available in the wrist. He/She'll ask you to bend your wrist down as
far as it will go and hold the position for 15 seconds up to four minutes. The
Doctor will be looking for signs of Carpal Tunnel Syndrome once they ask you to
stop holding the position.
Nerve Conduction Velocity: The Doctor will
take out a small box with two probes that He/She'll place on your wrist. These
probes will measure the nerve's ability to transmit electrical impulses to
Musculature. If electrical impulses are slowed in the Median Nerve through the
Carpal Tunnel then you may have Carpal Tunnel Syndrome.
X Rays and Blood Tests: Some Doctors will
ask for some X Rays and some blood drawn so as to get a better understanding if
there are any other reasons why Carpal Tunnel Syndrome may be occurring.
Please realize that all of the above tests
are painless
Treatment
Well now your Doctor tells you that you
indeed do have Carpal Tunnel Syndrome. What happens now? Any number of things.
First your Doctor could tell you that He/She caught it early enough so all you
have to do is get a wrist rest and an Ergonomic Glove and you'll be all set. The
next option(s) could be to inject the area of inflammation with Corticosteroids,
Or Cortisone type medications. OR some nonsteroidal type of Anti-Inflammatory
Drugs. IF the drugs are not effective there are other options available. Such
things as splints, treatment with Vitamin B6, Acupunture, Massage of the
effected area, as well as numerous other options. Again check with your Doctor
to find what would be best for you. The last option is surgery. This maybe
required to relieve the inflammation and to avoid permanent damage to the Carpal
Tunnel itself. The operation is called a "Carpal Tunnel Release" . It is a
relatively minor operation and can be done on an outpatient basis. The basic
steps are as follows:
