When one suffers from Carpal Tunnel Syndrome (CTS), the pain can really interfere with a persons day!

First a little anatomy: The carpal tunnel is made up of small bones in the wrist called carpals on one side, and then a thick ligament called the Transverse Carpal Ligament on the other. Living in the tunnel are the finger tendons and the neuro/vascular bundle that includes the Median Nerve:

The Carpal Tunnel

In the case of Carpal tunnel Syndrome, what happens is that the finger flexor tendons get irritated enough so as to cause the Median Nerve to be compromised. This can happen for many reasons:

• The finger flexor tendons are too thick
• The Transverse Carpal Ligament is to thick
• The carpal bones are too small

The result of these predisposing factors is that the finger flexor tendons cause friction as they move over one another and the heat generated results in local inflammation. This inflammation irritates the nerve and the pain that results is what one experiences when they have Carpal Tunnel Syndrome.  The reason there is so much pain associated with Carpal Tunnel Syndrome is because of the pressure on the Median Nerve. That is why it is also known as a Median Neurapthy at the wrist. In severe cases, there can be sufficent compression on the Median Nerve causing muscle atrophy andmotor weakness in turn.

The most common cause of Carpal Tunnel Syndrome is repetitive use, which is why it is most common in people who have jobs where repetitive use of the hands is part of a normal day. It was rare to see CTS in people who used typewriters for instance, but now we see quite a bit of it in peole who use computers every day. Other causes are trauma, hypothyroidism, during the period of pregnancy, amyloid, acromegaly, multiple myeloma, rheumatoid arthritis, muco polysaccharidoses.

Treating CTS involves behavior modification, as in changing the work environment by doing such things as using a pad to rest the hands on while typing, as well as using wrist splints that also splint the fingers. Remember it is the finger flexors that need to be quieted down, so a splint that does not also extend to the fingertips does no good during the day. At night, a splint that keeps one from curling the wrists up under the chin will do the trick.

Ice is good to use to reduce edema and lower the impact of inflammation, and anti-inflammatory drugs are good to take by prescription.

Once the pain settles down, then grip strength training is worthwhile, and overall upper body strengthening is a good plan.

Prevention should include interrupting your work, improving the biomechanics and ergonomics around your work, splinting at night to prevent night time compression, and use of ice daily to keep the swelling down. NSAID’s as prophylaxis might also be a good idea.