Carpal Tunnel Syndrome


It’s been a hard day working from home during quarantine. You’ve been sitting at the keyboard for 10-12 hours. After numerous video calls and teleconferences, you finally turn in and go to bed. It’s morning, and you wake up. What is that you feel in your hand? Is your arm asleep? Is there numbness? Pain? Tingling? Is this the dreaded carpal tunnel syndrome that your coworkers have mentioned? What should you do now? What is even happening? And what the heck is a carpal?

What is it?
Carpal Tunnel Syndrome, or CTS, is a form of nerve compression at the level of the wrist. It affects between about 3-6% of the population. CTS is one of the most common forms of nerve entrapment disorders. Symptoms include numbness, paresthesia (pins and needles), weakness, or pain affecting the thumb, index, middle and half of the ring finger. Symptoms are often worse at night, and given enough time, will progress far enough to cause weakness in your grip and pinch strength.

So what is happening exactly?
The Carpal Tunnel is a space within your wrist that is surrounded by the Transverse Carpal Ligament. Under the ligament is the carpal tunnel, where the median nerve runs with nine tendons from your flexor muscles (that help you make a fist).
When there is increased pressure within the tunnel, the accumulated forces compress the median nerve. Prolonged compression may result in permanent damage to the nerve with lasting effects.

What are the causes?
Risk factors include diabetes, obesity, pregnancy, genetics, rheumatoid arthritis, thyroid disorders, repetitive wrist motions, and prolonged use of vibrational work tools and devices. Females and individuals aged 50-54 are more likely to be affected than others. Sometimes, the presence of a cyst, tumor, or scar tissue can also increase the pressure within the carpal tunnel, causing compression of the nerve.
Interestingly enough, the current literature has not been able to prove excessive keyboarding to be the primary cause of CTS. In contrast, there is strong evidence between increased hand force, repetitive wrist motion, repeated use of vibrational tools, and extreme wrist flexion/extension to be more strongly correlated with CTS. Sometimes, even irritation or swelling of the flexor tendons (the muscles adjacent to the median nerve) may also cause some nerve compression.

Interestingly enough, the current literature has not been able to prove excessive keyboarding to be the primary cause of CTS. In contrast, there is strong evidence between increased hand force, repetitive wrist motion, repeated use of vibrational tools, and extreme wrist flexion/extension to be more strongly correlated with CTS. Sometimes, even irritation or swelling of the flexor tendons (the muscles adjacent to the median nerve) may also cause some nerve compression.

Enough! What can I do to treat it?
Don’t panic! It is recommended to follow up with a medical practitioner who specializes in hands. These doctors may order an EMG, or Electromyography nerve conduction study that measures the speed and strength of impulses traveling down your nerve to confirm if compression is truly present. Doctors also have a myriad of other tests they perform to see if you truly have CTS.
If symptoms persist, worsen, or begin to impact your ability to function and perform daily activities, doctors may recommend a surgery called Carpal Tunnel Release, or CTR. During the surgery, the surgeon performs a longitudinal incision along the transverse carpal ligament to relieve pressure in the carpal tunnel, while avoiding the median nerve altogether. There is very strong evidence that the surgery improves function with lasting results, and most patients recover swiftly with minimal problems.

Not down for surgery?
No worries, conservative management has been found to be 65% effective in patients with carpal tunnel syndrome. This involves seeing a hand therapist (that’s me!) to learn techniques to avoid repetitive wrist motions, being fitted and fabricated with a custom-molded wrist immobilization orthosis, and receiving massages to the extrinsic flexor forearm muscles if there is inflammation of the flexor tendons.

Preventative measures
The best way to avoid CTS (and the surgery!) is to maintain neutral wrist positioning at all times, taking frequent rest breaks from repetitive activities, and communicating with your workplace’s HR for preventative accommodations. Combining this with wearing the custom-molded wrist orthosis at night while you sleep, symptoms are very likely to subside.

Final Note
Patients always ask me when they should see a doctor or if they should consider surgery. While I can’t answer that for you, I always share this piece of advice:
Nerves and nerve compression are like parking a car on a field of grass. If you park a car on grass for a few days, and then move the car, what happens? It takes a few weeks, but the grass eventually grows back. But what happens if you park a car over grass for a year? Two years? Five years? When you finally move that car, the grass never fully grows back.
Most individuals with desk jobs probably don’t have CTS. But if you believe you are experiencing the aforementioned symptoms, try employing the preventative techniques I shared. If you still aren’t sure what’s going on, I recommend scheduling a telehealth visit with a hand specialist today for further ergonomic assessment.

In good health,
Raymond Nguyen, MS, OTR/L
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