Carpal Tunnel Syndrome (CTS)

August 3, 2011

The carpal tunnel is formed within a bracelet of small bones located at the top of the wrist and a tough fibrous tissue known as the transverse carpal ligament located on the underside of the wrist. The median nerve and the tendons that flex and extend the fingers pass through this small tunnel. Carpal tunnel syndrome (CTS) is a musculoskeletal disorder that occurs when the median nerve, which runs from the forearm to the hand, becomes compressed or pinched at the wrist. This can cause pain, weakness, numbness, or tingling in the affected hand and fingers. Carpal tunnel syndrome has been attributed to a combination of factors, including fluid retention from pregnancy, swelling of the tendon within the carpal tunnel, or from arthritis and certain hormonal disorders, such as diabetes, thyroid disorders, and during menopause. Repetitive bending and extending of the tendons in the hands and wrists, especially when done in a forceful manner for long periods without rest, can also increase pressure within the carpal tunnel. Such postures of the hands and wrists often occur in job-related circumstances in which the worker might perform repeated movements of the hands; hold the wrist in awkward postures, such as in a bent position; use forceful grips such as holding a tool too tightly because it is too big or heavy; or exert pressure on the wrist by using the palm of the hand as a hammer or by frequently resting the wrist on a hard surface. Frequent use of vibrating hand tools is also a risk for Carpal tunnel syndrome. Individuals who work in assembly jobs using their hands, such as appliance manufacturing, meat, poultry, or fish preparation, sewing, grocery checking, carpentry, and other jobs where there is a combination of highly repetitive, forceful work have been found to be at increased risk for Carpal tunnel syndrome. Frequent use of the computer keyboard has also been implicated in Carpal tunnel syndrome. The highly repetitive and forceful work using awkward postures may also be encountered in certain hobbies, such as woodworking, knitting, or crocheting.

The most common symptoms of Carpal tunnel syndrome include numbing, tingling, and pain on the palm side of the thumb and fleshy part of the palm near the thumb, the front and back of the index and long fingers, as well as the lateral side of the ring finger. In some cases, pain may also extend up the arm to the elbow and shoulder. Depending on the severity of the condition, symptoms may also involve hand weakness, the inability to grip items, and include changes in touch and sensitivity to temperature. The first symptoms, usually numbness and tingling, often happen at night.

It is estimated that approximately 3-4% of the general population in the united States has symptoms consistent with Carpal tunnel syndrome. Although women are approximately three times more likely to develop Carpal tunnel syndrome, it is also diagnosed in men. This increased prevalence of Carpal tunnel syndrome in women may be due to the smaller size of the carpal tunnel or perhaps to jobs involving repetitive use of their hands. Carpal tunnel syndrome is diagnosed through a combination of clinical examinations and specialized tests, usually involving electrodiagnostic testing of the median nerve in the wrist.

Treatments for Carpal tunnel syndrome range from resting the limb and avoiding the activities that may be causing the nerve compression and symptoms, and immobilizing the affected hand and wrist at night using a rigid splint, to surgery to release the pinched median nerve. Recommendations for treatment are based on the judgment of the diagnosing physician and are dependent upon many considerations. More importantly, however, efforts should be placed on prevention, working collaboratively with employee-management teams in the case of factors related to the workplace to evaluate the work environment, including the workstation and the tools themselves; the repetitive movements involved in getting a task accomplished; and the possibility of incorporating rest breaks or rotating to different jobs.

SEE ALSO: Tendonitis, Women in the Workforce


Category: C