What is Carpal Tunnel Syndrome?

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome occurs due to the compression of the nerve in your wrist called median nerve.   It runs from the forearm into the hand.  Compression occurs due to the narrowing of the tunnel in your wrist when there is inflammation and swelling in the area.

Symptoms

• frequent burning, pins and needles, or numbness in the palm of the hand and the fingers, especially the thumb and the index and middle finger
• increased pain at night which can be relieved by shaking out of hands
• weak grip and tendency to drop objects held in the hand
• wasting away of the muscles at the base of the thumb in later
• some may be unable to identify hot and cold by touch

Causes

• repetitive use of wrist and hand
• forceful and stressed motions of the hand and wrist
• trauma or injury to the wrist
• fluid retention during pregnancy or menopause
• disease causing carpal tunnel syndrome
• development of a cyst or tumor in the canal
• congenital predisposition

What are the available treatment options?

Non-surgical Treatments

Drugs

• Non-steroidal anti-inflammatory drugs and other pain relievers may ease the symptoms.  Exercise - Stretching and strengthening exercises can be helpful. These exercises may be supervised by a physical therapist or an occupational therapist.  Alternative therapies – Acupuncture, chiropractic care and yoga have benefited some patients. Wrist splinting - A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of pain.

Surgical Treatments

• In all accepted surgical procedures, the doctor cuts the ligament pressing the nerve.  Surgery usually results in marked improvement, but some residual numbness, pain, stiffness or weakness may still be experienced.

Caring for your Wrist and Hand

Your Doctor will examine your shoulder and may take x-rays. In some cases, he or she may want to do an arthrogram (an x-ray of your shoulder after dye is injected in to your shoulder joint) or an MRI (Magnetic Resonance Imaging) scan.

DOs

Standing
Open fingers and use pad of hand when needed. Put extra cushions of folded blanket on seats to avoid using hands for pushing up to stand. Grip-Hold thick-handled tools in dagger fashion whenever possible for performing tasks such as stirring or scrubbing. Relax fingers every 10 minutes during activity.

Ulnar deviation

• Use devices like bottle / can / jar openers to assist with activities.
• Reposition work materials, or move yourself to approach from different angles.

Use large joints
Transfer work to other body parts that are not affected or have greater strength. Using body weight to push heavy doors open is an example. 

Pinch
Use thick pen with felt tip for reducing pressure on fingers.

Carrying
Use a back pack or shoulder bag instead of hand bag.

Wringing
Loop towel around sink faucet as if braiding and pull gently, or let drip dry.

Lifting
Use both hands and slide them whenever possible.

Supination
Use both hands to pick up. Take frequent breaks during the day.

Wrist flexion
Change the work height so wrist can be held straight.  Vary tasks during the day.

Wrist extension
Change the work height so wrist can be held straight. If keyboard is too low / high adjust desk / chair to correct.

Pressure areas
Pad table edge, if needed, with towel.  Remove bulky wrist jewelry when resting arm on table.

DON’Ts

Standing
Avoid putting any pressure on bent knuckles.

Grip
Avoid grasping thin utensils for prolonged periods.

Ulnar deviation

• Avoid twisting of hand and sliding fingers sideways toward little finger side.
• Avoid placing hand into position where wrist is angled toward little finger side

Use large joints
Avoid placing pressure on fingertips.

Pinch
Avoid pinching motions such as holding a pen.

Carrying
Avoid carrying items with weight on fingers.   

Wringing
Avoid wringing towels by twisting.

Lifting
Avoid picking up heavy items with one hand.

Supination
Avoid repetitive use of one hand with palm turning upward

Wrist flexion
Avoid prolonged holding of wrist in downward position

Wrist extension
Avoid prolonged holding of wrist in upward position.

Pressure areas
Avoid pressure at the wrist and base of palm.

References :
https://www.mayoclinic.com/health/carpal-tunnel-syndrome/DS00326
https://www.mayoclinic.org/carpal-tunnel-syndrome
https://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm
O'Sullivan,  S.B.,  and Schmitz, T.J.:  Physical Rehabilitation: Assessment & Treatment,  4th ed.  FA Davis
Company, Philadelphia, 2001.

Note:  This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment. If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

For more information, please call:

ORTHOPEDIC MULTISPECIALTY CLINIC

Tel. nos. (632) 988-1000 / (632) 988-7000 ext. 6521 

DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION

Tel. nos. (632) 988-1000 / (632) 988-7000 locals 6240/6241

CENTER FOR PATIENT PARTNERSHIP

Tel. nos. (632) 988-1000 / (632) 988-7000 locals 6444