Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a Repetitive Strain Injury (RSI) and is an injury that may affect functionality and sensation in the hand and wrist. Though many factors may contribute towards a person suffering from this condition, it is most commonly a workplace injury affecting office workers. Ideally, the human body should be positioned in a series of straight lines and 90 degree angles as a person works and types at their computer. If the long axis of the hand is not in perfect alignment with the long axis of the forearm as we type and use our computer mouse, the ligaments and bones of the wrist and hand may come under strain. Eventually, the median nerve that runs from the forearm to the hand may become constricted as the ligaments around it become inflamed, due to the repetitive strain. Eventually you may experience numbness in your hand and wrist, and this area may begin to stiffen and become painful. Eventually, the pain may radiate to your fingers and up your arm as the median nerve becomes more suffocated. Without conservative or surgical treatment, it may become you may experience disability of this wrist and hand.

Cause: The median nerve is located in a passageway - known as the carpal tunnel, along with several ligaments and muscles, including the Flexor digitorum profundus muscle and Transverse carpal ligament. This carpal tunnel area is sandwiched in between the row of carpal bones of the hand closest to the fingers. Due to certain overuse injuries, such as when a person's wrist is bent while working at a computer workstation, inflammation may occur in the muscles and ligaments of the carpal tunnel, and the medial nerve may become constricted. Treatment for this entrapment of the medial nerve may include either conservative treatments to reduce the inflammation of the affected tissues, or surgery to remove some tissue structures in the carpal tunnel to free up some space.

The most common cause of carpal tunnel syndrome involves office work in which a person is regularly typing at the computer. Genetics and body mechanics may also play factors, as evidenced by the fact that not all people who spend a large part of their workday typing develop CTS.

Symptoms: The primary symptom of this condition is numbness of the first three digits of the hand (thumb, index, and middle finger). The numbness may be constant, though it is more commonly present at night, possibly due to the natural flexion of the wrist that occurs when we fall asleep. Prolonged weeks or months of this constriction of the medial nerve may lead to constant day and night numbness, eventual atrophy of the muscles that the nerve supports, and the loss of function. A person with untreated nerve entrapment may lose their ability to perform wrist abduction (turning of the wrist away from the midline if the body).

Compression of the medial nerve may cause pain that is severe enough to prevent a person from going to sleep, or wake a person from sleep. The pain may radiate proximally (toward the forearm) or distally (towards the fingers).

Treatment: Therapy for this condition may include surgical or non-surgical treatments. Non surgical treatments may include:
  • Medications to reduce the inflammation of the affected muscles and connective tissues (ligaments and tendons): The medications may include NSAIDs (Nonsteroidal anti-inflammatory medications) or steroidal medications such as corticosteroids.
  • The treatment may include a wrist splint that is worn on the hand to prevent flexion, while a person is working or when sleeping at night. In some cases, a person may wear a wrist splint all the time until the pain and sensory (numbness) symptoms have subsided.
  • Consultation with an occupational therapist: Regardless of whatever drugs you take or what temporary bracing you use, you must improve your body mechanics in order to avoid a re-occurrence of this injury.