Carpal Tunnel Syndrome (CTS) may be the most expensive of all work-related injuries, costing the average CTS patient about $30,000 in medical bills and lost productivity over his or her lifetime. CTS is primarily found in adults, is 3x more frequently found in woman, and usually affects the dominant hand first. The pain can be quite severe and disabling. Certain occupations tend to associated with CTS more than others, such as manual labor jobs (assembly-line / manufacturing, sewing, finishing, cleaning, meatpacking, and food processing and packing occupations). Jobs that involve heavy computer work, playing a musical instrument, and waiting tables can also increase an individual’s risk for CTS, as can certain medical conditions such as diabetes, obesity, pregnancy, the use of birth control pills, inflammatory arthritis, and hypothyroidism.
CTS is caused by a pinch to the median nerve that runs down the arm from the neck, through shoulder, elbow, and wrist. The pinch can occur in one or more of these locations making it important to obtain a complete evaluation including the neck and upper arm – not just the wrist. There are a total of 9 tendons, ligaments, and blood vessels jammed into the tight confines of the carpal tunnel formed by 8 small carpal bones and the transverse carpal ligament that serves as the “roof” of the tunnel. Symptoms include burning, tingling, aching, and/or numbness primarily into the 2nd to 4th fingers and at times, the thumb. Some sufferers develop weakness in their grip making it hard to open jars, turn stubborn door knobs, or hold on to a newspaper or steering wheel. Waking up multiple times at night is also a common complaint caused by sleeping with the wrist bent, which increases the pressure inside the tunnel, thus pinching the nerve more firmly.
Diagnosis is made by reproducing the symptoms by further compressing the median nerve inside the tunnel. This is accomplished by applying pressure over the tunnel, by bending the patient’s wrists 90 degrees backwards (dorsiflexion) and forwards (palmar flexion), or by placing compression over the proximal forearm, at the thoracic outlet (under the collar bone) and / or at the neck. Special tests like an EMG/NCV (electromyogram and nerve conduction velocity) can determine the degree of nerve damage and verify the diagnosis. At times, x-ray or MRI are helpful if arthritis or a bone spur is suspected or to measure the size of the carpal tunnel. Laboratory blood tests to determine secondary causes, described earlier, may also be ordered.
Treatment consists of 1. Rest; 2. Modifying the activity or workstation suspected of causing CTS; 3. Using a splint- especially at night and when driving; and 4. Managing any underlying disease condition. Managing inflammation is also important, which can be accomplished by the use of ice. (Ice massage is very effective. This consists of freezing water in paper cups, tearing off the top half of the cup, and rubbing the ice against the skin for approximately 5 minutes. The sequence of sensations includes cold, burning, aching, and numbness or “C-BAN”. Make sure you quit when numbness is reached, as frost bite is a risk if performed for too long.) Anti-inflammatory herbal remedies such as ginger, turmeric, boswellia, and/or vitamins like bromelain & papain, vitamin B6, fish oil (omega 3 fatty acids, vitamin D (2000-5000IU); calcium/magnesium, are all potentially helpful. Manual manipulations to the joints of the neck, shoulder, elbow, wrist, and hand and soft tissue manipulation to the muscles and tendons of the forearm and hand can also benefit patients. Other non-surgical treatments include exercises and physical therapy modalities such as low level laser therapy, electrical stimulation, and ultrasound.
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