Carpal Tunnel Syndrome (CTS) can present with a very mild, occasional numbness or tingling in the thumb, index, middle, and ring fingers and may never progress much beyond that point. But, for other patients, CTS is a painful, rapidly progressive problem that requires immediate attention. What makes it mild for some and bad for others? Let’s take a look!
The common denominator of CTS is median nerve compression at the wrist resulting in the tingling, burning, itching in the palm, thumb, and fingers (except the little finger). Symptoms can also include weakness in grip strength, as the median nerve innervates muscles that help you grip things with your hands. The compression may occur from the nerve becoming swollen, inflammation of the surrounding tendons, a cyst forming in the tunnel (ganglion cyst is most common), and/or a bony spur from arthritis poking into the tunnel. There are other causes or “contributors” of CTS that may make it more intense for some than others. Fluid retention or edema can increase the pressure in the carpal tunnel. This can be caused by pregnancy, taking birth control pills, or by hormone replacement therapy (estrogen for osteoporosis and/or hot flashes). Another type of edema (called myxedema) is associated with low thyroid function, and CTS can be caused or worsened in those with hypothyroidism. Obesity is another risk factor for developing CTS. The shape of the wrist may also predispose some to CTS and when combined with other contributing causes, CTS symptoms may become quite severe. Trauma or injuries to the upper limb, especially fractures at the wrist, can cause CTS almost immediately, and an improperly treated wrist fracture (such as a colles fracture) can result in long-term CTS. Arthritis is often accelerated when wrist fractures occur and this can result in a long-term problem that includes stiffness in the joint with loss of movement and pain in addition to CTS signs and symptoms.
Another cause of CTS is diabetes. For diabetics, their blood can be thicker and have a more difficult time traveling through the small blood vessels (called capillaries) resulting in numbness and tingling of the distal extremities: the hands and feet. Over time, neuropathy creates a hypersensitivity of the nerve, and this can result in carpal tunnel syndrome and/or can make it more difficult to manage. It has also been reported that the use of insulin, metformin, as well as sulphonylureas, and thyroxine are associated with increased CTS management challenges. Over-activity of the pituitary gland (the “master gland”) as it regulates the endocrine system is another contributor to CTS. Rheumatoid arthritis is a connective tissue disorder where antibodies inappropriately attack the lining of the joints creating swelling and pain. This can result in increased pressure on the median nerve in the carpal tunnel from both the inflamed joint as well as inflammation of the surrounding soft tissue. Combinations of these may also occur, which can make it challenging to determine which one(s) is the primary issue. Side effects to certain medications such as aromatase inhibitor drugs for breast cancer are also been well-published causes of CTS symptoms
The following activities have also been associated with an increased risk for CTS: vibrating hand tools, carrying heavy trays of food, working in a highly repetitive assembly-line type of job, milking cows, gardening, knitting, playing musical instruments, computer use, painting, meat and poultry processing, and carpentry.
Chiropractic offers a non-drug, non-surgical approach that is highly effective and therefore should be your FIRST STEP in the management of CTS!