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What is Carpal Tunnel
Syndrome (CTS)?
Carpal Tunnel Syndrome (CTS)
is the name for a group of
problems that includes
swelling, pain, tingling,
and loss of strength in your
wrist and hand. Your wrist
is made of small bones that
form a narrow groove or
carpal tunnel. Tendons and a
nerve called the median
nerve must pass through this
tunnel from your forearm
into your hand. The median
nerve controls the feelings
and sensations in the palm
side of your thumb and
fingers. Sometimes swelling
and irritation of the
tendons can put pressure on
the wrist nerve causing the
symptoms of CTS. A person’s
dominant hand is the one
that is usually affected.
However, nearly half of CTS
sufferers have symptoms in
both hands.
CTS has become more common
in the U.S. and is quite
costly in terms of time lost
from work and expensive
medical treatment. The U.S.
Department of Labor reported
that in 2003 the average
number of missed days of
work due to CTS was 23 days,
costing over $2 billion a
year. It is thought that
about 3.7 percent of the
general public in this
country suffer from CTS.
What are the symptoms of
CTS?
Typically, CTS begins slowly
with feelings of burning,
tingling, and numbness in
the wrist and hand. The
areas most affected are the
thumb, index and middle
fingers. At first, symptoms
may happen more often at
night. Many CTS sufferers do
not make the connection
between a daytime activity
that might be causing the
CTS and the delayed
symptoms. Also, many people
sleep with their wrist bent,
which may cause more pain
and symptoms at night. As
CTS gets worse, the tingling
may be felt during the
daytime too, along with pain
moving from the wrist to
your arm or down to your
fingers. Pain is usually
felt more on the palm side
of the hand.
Another symptom of CTS is
weakness of the hands that
gets worse over time. Some
people with CTS find it
difficult to grasp an
object, make a fist, or hold
onto something small. The
fingers may even feel like
they are swollen even though
they are not. Over time,
this feeling will usually
happen more often.
If left untreated, those
with CTS can have a loss of
feeling in some fingers and
permanent weakness of the
thumb. Thumb muscles can
actually waste away over
time. Eventually, CTS
sufferers may have trouble
telling the difference
between hot and cold
temperatures by touch.
What causes CTS and who is
more likely to develop it?
Women are three times more
likely to have CTS than men.
Although there is limited
research on why this is the
case, scientists have
several ideas. It may be
that the wrist bones are
naturally smaller in most
women, creating a tighter
space through which the
nerves and tendons must
pass. Other researchers are
looking at genetic links
that make it more likely for
women to have
musculoskeletal injuries
such as CTS. Women also deal
with strong hormonal changes
during pregnancy and
menopause that make them
more likely to suffer from
CTS. Generally, women are at
higher risk of CTS between
the ages of 45 and 54. Then,
the risk increases for both
men and women as they age.
There are other factors that
can cause CTS, including
certain health problems and,
in some cases, the cause is
unknown.
These are some of the things
that might raise your
chances of developing CTS:
Genetic predisposition. The
carpal tunnel is smaller in
some people than others.
Repetitive Movements. People
who do the same movements
with their wrists and hands
over and over may be more
likely to develop CTS.
People with certain types of
jobs are more likely to have
CTS, including manufacturing
and assembly line workers,
grocery store checkers,
violinists, and carpenters.
Some hobbies and sports that
use repetitive hand
movements can also cause
CTS, such as golfing,
knitting, and gardening.
Whether or not long-term
typing or computer use
causes CTS is still being
debated. Limited research
points to a weak link, but
more research is needed.
Injury or Trauma. A sprain
or a fracture of the wrist
can cause swelling and
pressure on the nerve,
increasing the risk of CTS.
Forceful and stressful
movements of the hand and
wrist can also cause trauma,
such as strong vibrations
caused by heavy machinery or
power tools.
Pregnancy. Hormonal changes
during pregnancy and build
up of fluid can put pregnant
women at greater risk of
getting CTS, especially
during the last few months.
Most doctors treat CTS in
pregnant women with wrist
splits or rest, rather than
surgery, as CTS almost
always goes away following
childbirth.
Menopause. Hormonal changes
during menopause can put
women at greater risk of
getting CTS. Also, in some
postmenopausal women, the
wrist structures become
enlarged and can press on
the wrist nerve.
Breast Cancer. Some women
who have a mastectomy get
lymphedema, the build-up of
fluids that go beyond the
lymph system's ability to
drain it. In mastectomy
patients, this causes pain
and swelling of the arm.
Although rare, some of these
women will get CTS due to
pressure on the nerve from
this swelling.
Medical Conditions. People
who have diabetes,
hypothyroidism, lupus,
obesity, and rheumatoid
arthritis are more likely to
get CTS. In some of these
patients, the normal
structures in the wrist can
become enlarged and lead to
CTS.
Also, smokers with CTS
usually have worse symptoms
and recover more slowly than
nonsmokers.
How is CTS treated?
It is important to be
treated by a doctor for CTS
in order to avoid permanent
damage to the wrist nerve
and muscles of the hand and
thumb. Underlying causes
such as diabetes or a
thyroid problem should be
addressed first. Left
untreated, CTS can cause
nerve damage that leads to
loss of feeling and less
hand strength. Over time,
the muscles of the thumb can
become weak and damaged. You
can even lose the ability to
feel hot and cold by touch.
Permanent injury occurs in
about 1 percent of those
with CTS.
CTS is much easier to treat
early on. Most CTS patients
get better after first-step
treatments and the following
tips for protecting the
wrist. Treatments for CTS
include the following:
Wrist Splint. A splint can
be worn to support and brace
your wrist in a neutral
position so that the nerves
and tendons can recover. A
splint can be worn 24 hours
a day or only at night.
Sometimes, wearing a splint
at night helps to reduce the
pain. Splinting can work the
best when done within three
months of having any
symptoms of CTS.
Rest. For people with mild
CTS, stopping or doing less
of a repetitive movement may
be all that is needed. Your
doctor will likely talk to
you about steps that you
should take to prevent CTS
from coming back.
Medication. The short-term
use of nonsteroidal
anti-inflammatory drugs (NSAIDs)
may be helpful to control
CTS pain. NSAIDs include
aspirin, ibuprofen, and
other non-prescription pain
relievers. In severe cases,
an injection of cortisone
may help to reduce swelling.
Your doctor may also give
you corticosteroids in a
pill form. But, these
treatments only relieve
symptoms temporarily. If CTS
is caused by another health
problem, your doctor will
probably treat that problem
first. If you have diabetes,
it is important to know that
long-term corticosteroid use
can make it hard to control
insulin levels.
Physical Therapy. A physical
therapist can help you do
special exercises to make
your wrist and hand
stronger. There are also
many different kinds of
treatments that can make CTS
better and help relieve
symptoms. Massage, yoga,
ultrasound, chiropractic
manipulation, and
acupuncture are just a few
such options that have been
found to be helpful. You
should talk with your doctor
before trying these
alternative treatments.
Surgery. CTS surgery is one
of the most common surgeries
done in the U.S. Generally,
surgery is only an option
for severe cases of CTS
and/or after other
treatments have failed for a
period of at least six
months. Open release surgery
is a common approach to CTS
surgery and involves making
a small incision in the
wrist or palm and cutting
the ligament to enlarge the
carpal tunnel. This surgery
is done under a local
anesthetic to numb the wrist
and hand area and is an
outpatient procedure.
What is the best way to
prevent CTS?
Current research is focused
on figuring out what causes
CTS and how to prevent it.
The National Institute of
Neurological Disorders and
Stroke (NINDS) and the
National Institute of
Arthritis and
Musculoskeletal and Skin
Diseases (NIAMS) support
research on work-related
factors that may cause CTS.
Scientists are also
researching better ways to
detect and treat CTS,
including alternative
treatments such as
acupuncture.
For more information on
research, contact:
NINDS at
http://www.ninds.nih.gov
or call 1-800-352-9424
NIAMS at
http://www.niams.nih.gov
or call 1-301-496-8190 or
1-877-226-4267.
The following steps can
help to prevent CTS:
Prevent workplace
musculoskeletal injury. Make
sure that your workspace and
equipment are at the right
height and distance for your
hands and wrist to work with
less strain. If you are
working on a computer, the
keyboard should be at a
height that allows your
wrist to rest comfortably
without having to bend at an
angle. Desk or table
workspace should be about 27
to 29 inches above the floor
for most people. It also
helps to keep your elbows
close to your sides as you
type to reduce the strain on
your forearm. Keeping good
posture and wrist position
can lower your risk of
getting CTS.
Take Breaks. Allowing your
hand and wrist to rest and
recover every so often will
lower your risk of swelling.
Experts believe that taking
a 10 to 15 minute break
every hour is a good way to
prevent CTS.
Vary Tasks. Avoid repetitive
movements without changing
up your routine. Try to do
tasks that use different
muscle movements during each
hour. Break up tasks that
require repetitive wrist and
hand motion with those that
do not.
Relax Your Grip. Sometimes,
people get into a habit of
tensing muscles without
needing to. Practice doing
hand and wrist motion tasks
more gently and less
tightly. Stress and tension
play a role in muscle strain
and irritation.
Do exercises. After doing
repetitive movements for a
while, you can sometimes
cancel out the effects of
those movements by flexing
and bending your wrists and
hands in the opposite
direction. For example,
after typing with your wrist
and hand extended, it is
helpful to make a tight fist
and hold it for a second,
then stretch out the fingers
and hold for a few seconds.
Try repeating this several
times.
Stay Warm. Muscles that are
warm are less likely to get
hurt and the risk of getting
CTS is greater in a cold
environment. It is important
to keep your hands warm
while you work, even if you
must wear fingerless gloves.
For More Information….
For more information on
carpal tunnel syndrome,
contact the National Women’s
Health Information Center at
1-800-994-9662 or the
following organizations:
National Institute of
Arthritis and
Musculoskeletal and Skin
Diseases Information
Clearinghouse, NIAMS, NIH,
HHS
Phone: (301) 495-4484,
(301) 565-2966 TTY, (301)
881-2731 Faxback System,
(877) 226-4267
Internet Address:
http://www.niams.nih.gov/
National Institute of
Neurological Disorders and
Stroke, NIH, HHS
Phone: (301) 468-5981
TTY, (301) 496-5751
(Information Office),
(800) 352-9424
Internet Address:
http://www.ninds.nih.gov/
National Institute for
Occupational Safety and
Health (NIOSH) Publications
Office
Phone: (513) 533-8471,
(800) 356-4674
Internet Address:
http://www.cdc.gov/niosh/pubs.html
American Academy of
Orthopaedic Surgeons
Phone: (847) 823-7186,
(800) 346-2267, (800)
999-2939 (Fax on Demand)
Internet Address:
http://www.aaos.org/
American Chronic Pain
Association
Phone: (916) 632-0922
Internet Address:
http://www.theacpa.org/
American Society for
Surgery of the Hand
Phone: (404) 523-8821
Fax on Hand, (800) 905-4263
Fax on Hand
Internet Address:
http://www.hand-surg.org/
This FAQ was reviewed by
Mustafa Haque, M.D.,
Georgetown University
Hospital, Washington, D.C.
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