Carpal tunnel syndrome (CTS)

By Dr. Vic Weatherall

Carpal tunnel syndrome (CTS) arises primarily from compression of the median nerve as it passes through the ligamentous and bony tunnel formed by the wrist due to ligamentous laxity or tendonitis. It is the most common compression nerve compression injury in the body and it is the most common and costly repetitive strain injury. Carpal tunnel syndrome is two to five times more common in females and is most prevalent in persons aged 40-60.

What causes it?

Common causes of CTS include

• wrist area fractures
• recent excessive use of hands with repetitive finger or wrist flexion, fine hand movements, constant wrist pressure, and wrist vibration
• wrist sprains

Other causes include

• osteoarthritis (degenerative joint disease), joint dysfunction, or tendonitis in the wrist area
• systemic changes causing swelling (such as pregnancy) or metabolic diseases (such as diabetes)

What are the symptoms?

Typical symptoms of CTS include

• paresthesias (abnormal sensations) such as tingling and numbness in the thumb and index and middle fingers on the palm side
• night pain
• weakness in grasping, thumb and index finger pinching, and other thumb movements
• clumsiness, such as awkward hand movements and dropping things

How is it diagnosed?

The formal diagnosis of CTS is made by

• symptoms
• manual clinical tests, such as compressing the wrist bones to reproduce or increase the symptoms
• electroconductive studies of the median nerve, if required, to determine degree of nerve compromise

It is important to note that additional compression of the median nerve anywhere along its path, from the nerve roots in the neck to the forearm, can predispose, initiate, or exacerbate CTS; therefore, it is important to examine and treat the nerve along its course.

Note that symptoms similar to those of CTS can be caused by compression of the median nerve anywhere along its path from the nerve root to the hand; therefore, it is important to seek a proper diagnosis.

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How do I prevent it from happening to me?

To help prevent CTS

• Adopt correct sitting posture (see Ergonomics at Work).
• Ensure correct work station arrangement (Microsoft's Healthy Computer Guide).
• Avoid prolonged or repetitive wrist and finger flexion or extension.
• Avoid prolonged or repetitive grasping.
• Keep your wrists straight.
• Use a wrist support pad (keyboard support and mousepads).
• Periodically stretch and massage your forearm muscles.
• Periodically stretch your chest muscles.

How will my chiropractor, therapist, or medical doctor treat it?

There are many ways to treat CTS. Conservative treatment by chiropractors and therapists involves joint manipulation or mobilization, massage, stretching, splinting, rehabilitative exercises, and ice and heat. Vitamin B6 has also been promoted.

Medical treatment includes diuretics, sedatives, and nonsteroidal anti-inflammatories (NSAIDs) to provide temporary relief. When these fail, a physician may resort to corticosteriods or surgery to decompress the median nerve. However, steroid therapy may cause chemical nerve irriation and degeneration of the local tendons and bony structures. Surgery has its own complications including possible recurrence or worsening of the condition due to scaring; therefore, surgery should be used as a tool when all other treatment has been unsuccessful.

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