Carpal Tunnel Syndrome

We use our hands for everything. From eating to writing and typing, our hands are a huge part of everyday life, productivity, and independence. Pathologies affecting hand function are therefore detrimental in more ways than one. Carpal Tunnel Syndrome (CTS) is one such pathology. Individuals suffering from CTS find it hard to carry out everyday tasks and live with chronic pain.

CTS and the Wrist 

The carpal tunnel is a narrow passageway within the wrist. The carpal (or “wrist”) bones make up the base of this tunnel and the transverse carpal ligament makes up its roof. The tunnel provides a passageway for tendons involved in finger movement and for the median nerve. This nerve negotiates movement and sensation for much of the hand including the palm and fingers

Carpal tunnel syndrome (CTS) occurs when the carpal tunnel becomes narrow and exerts pressure, pinching the median nerve. Narrowing may be due to inflammation or swelling of structures within the carpal tunnel and proximal to it. Injuries and medical conditions that compromise circulation may also be a cause. Pressure on the median nerve leads to many uncomfortable symptoms including pain, numbness, tingling, and weakness. If left untreated, these symptoms get progressively worse and may cause irreparable damage.

 

Risk Factors that Contribute to CTS

Narrow Wrists:  Carpal tunnel syndrome is caused by a narrow passageway. It will come as no surprise that individuals who already have narrow wrists are more susceptible.

Wrist Injuries: the Previous injury to the wrist could have led to narrowing from scar tissue build-up or and alteration of the position of internal structures.

Repetitive Motions: Repetitive use of the wrist for specific motions leads to gradual wear-and-tear and inflammation. While these motions may not pose a problem in the short-run, they can lead to significant damage and narrowing if ignored.

Rheumatoid Arthritis (RA): RA involves inflammation of joint structures due to an autoimmune response. Inflammation to areas of the wrist can narrow the carpal tunnel and lead to long-term damage to surrounding structures as well as structures within.

Poor Circulation: Poor circulation can limit the movement of fluid in and out of tissues surrounding the wrist. Circulation problems also pose a risk of hypertension, obesity, hypothyroidism, and diabetes.

Potential Treatments

Treatment for carpal tunnel syndrome may vary with severity and cause. If CTS is mild to moderate, treatment may involve the use of a brace to keep wrists in a neutral position to aid in the discontinuation of detrimental movements. A shot of corticosteroids and NSAIDS may also be given to help with inflammation.

If the source of the narrowing involves damage and weakness of surrounding soft tissue structures, prolotherapy may be an option. Prolotherapy injections are known to repair and tighten injured soft tissues, associated pain, and may even repair nerve damage. 

Alternative treatments to lower inflammation and improve nerve response are also an option. This may include physical therapy for wrist and hand use, lymphatic massage to reduce swelling, and acupuncture treatments for inflammation and pain symptoms.

References:

  1. Burt, Susan, et al. “Prevalence and Incidence of Carpal Tunnel Syndrome in US Working Populations: Pooled Analysis of Six Prospective Studies.” Scandinavian Journal of Work, Environment & Health, 2013, https://www.academia.edu/14633062/Prevalence_and_incidence_of_carpal_tunnel_syndrome_in_US_working_populations_pooled_analysis_of_six_prospective_studies.
  2. Malahias, Michael Alexander, et al. “Single Injection of Platelet-Rich Plasma as a Novel Treatment of Carpal Tunnel Syndrome.” Neural Regeneration Research, Medknow Publications & Media Pvt Ltd, Nov. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705801/.

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