Carpal tunnel syndrome (CTS) is one of the most common causes of numbness, tingling and pain in the hand and fingers, particularly the thumb, index and middle fingers. Symptoms often come and go and are worse at night. One may wake up in the morning with achy and numb fingers and need to “shake it out” to return feeling to the hand. It is often bilateral, and is sometimes associated with weakness of the grip and dropping things.
Causes of CTS
CTS occurs in part because of the anatomy of the wrist. The median nerve goes through a narrow area in the wrist called the carpal tunnel, before dividing into the nerves that carry sensation and muscle impulses to the fingers. Symptoms of CTS are caused by compression of the median nerve in this channel.
The cause of the compression can be variable and may include swelling associated with pregnancy, low thyroid or arthritis. Assembly line type work significantly increases the risk of developing CTS, as does the repeated use of vibrating hand tools. Trauma and diabetes can be contributing factors. Although it is commonly associated with excessive typing, a recent Mayo Clinic study showed no clear link with computer use and CTS.
CTS Examination and Tests
Your neurologist will take a careful history and perform a neurological examination. If CTS is suspected, an EMG test is often requested. This test is scheduled as a separate visit. EMG stands for electromyogram, a diagnostic test used to measure the electrical activity of muscles and nerves that helps neurologists diagnose and make decisions about the treatment of your CTS.
Treatment of CTS
Specific treatment is dependent largely on the severity of your CTS. Your doctor will review contributing factors, such as cessation of certain repetitive activity and use of vibrating hand tools. Use of wrist splints may be prescribed. If your CTS is mild, your doctor may discuss anti-inflammatory medications, hand therapy and hand exercises. At a more significant level, local injection of steroids may be an option. In more severe cases, surgery is recommended, particularly if symptoms have been progressive or lasting more than 6 months. Surgery, which is performed under local anesthesia, relieves pressure on the median nerve by cutting the ligament overlying the nerve and opening up the carpal tunnel space. Carpal tunnel surgery often requires several weeks of recovery and hand therapy.
Prevention of CTS
Prevention of CTS rests on adapting the work place and daily activities. Research, particularly that under the sponsorship of the National Institute for Occupational Safety and Health, is advancing our understanding of this condition and its treatment.
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