Carpal Tunnel Syndrome, Explained
There are an estimated 3 million-plus diagnoses of Carpal Tunnel Syndrome (CTS) in the United States each year. And with more people working from home and spending countless hours on their computers and handheld devices (in less ‘ergonomically friendly’ workstation setups) because of the pandemic, these numbers may skyrocket in the months ahead.
CTS is a condition that affects the median nerve which runs through the carpal tunnel at the base of the palm side of the hand and when exposed to prolonged increases in pressure, it can lead to symptoms of pain, numbness, and tingling in the affected hand and specifically the thumb, index finger, middle finger and a portion of the ring finger. CTS tends to worsen if pressure on the nerve continues over time, so proper diagnosis and a treatment plan are essential.
Though CTS has been historically believed to be a condition that mostly affected people who work or spend extended periods of time on computers, that isn’t often the case. Some people with certain conditions may be more susceptible to carpal tunnel issues, no matter how much time they spend at a keyboard. In addition, occupations which are associated with prolonged exposure to vibration and/or pressure applied to the palm pose an additional risk of developing CTS. Because CTS is characterized by inflammation in the affected area, people with rheumatoid arthritis, diabetes, and hypertension (high blood pressure) are the three most often cited medical conditions associated with an increased CTS risk.
Of course, the best approach to CTS from a patient perspective is to have it evaluated as soon as it becomes a problem. Carpal Tunnel Syndrome is a nerve compression condition involving the median nerve. When nerves are compressed severely or even moderately compressed for an extended period, they begin to lose their ability to function correctly. Thus, patients experience progressive numbness, burning sensation, and can eventually develop muscle atrophy – specifically in the case of the median nerve, these involve the muscles that control thumb function.
To accurately diagnose CTS, a physician needs to evaluate the patient via specific physical examination findings and other diagnostic studies, when appropriate. For many people in the early stages of CTS, non-surgical treatments may include bracing, activity changes, specific types of strengthening exercises, non-steroidal anti-inflammatory medications, ergonomic assessments, supplements and/or steroid injections.
When CTS has progressed beyond the point of help by non-surgical methods, surgery to correct the issue may be considered. Carpal Tunnel Surgery is hugely effective. However, the key to the surgery’s success is that the correct diagnosis has been made before surgery. A nerve test indicating the presence and severity of median nerve compression confirms the diagnosis. The surgery is performed on an outpatient basis under local anesthesia (with or without sedation) and typically takes less than 20 minutes. Recovery is relatively quick from a surgical standpoint. The incision is small and heals in one week. Tenderness over the incision area can remain for a couple of weeks, so return to more strenuous activities is based on a patient’s vocational and recreational activities. Light activities resume immediately after surgery, but heavy lifting, weight-bearing, etc., may take 3-4 weeks. Our patients receive no activity restrictions after four weeks.
Many patients who suffer the debilitating effects of CTS often ask me if there was something they could have done to prevent it. Unfortunately, there are no clinically proven means by which to prevent Carpal Tunnel Syndrome. The best way to avoid CTS complications is, like most things in medicine, getting an accurate diagnosis in the condition’s early stages. Patient education is crucial for understanding what symptoms should prompt diagnostic testing and treatment to avoid progression and when to undergo treatment to prevent long-term complications.
Even though complete prevention of CTS may not be possible, certain behavioral modifications can help reduce the risk of developing it:
- Eliminate or significantly reduce tobacco use or alcohol in excess.
- Optimal sugar management for people with diabetes.
- Pay attention to posture and wrist/hand position at workstations where the patient may spend extended periods.
Similarly, for those of us performing repetitive activities for extended periods or exposed to high vibration/compression activities (jackhammering, long motorcycle rides, etc.) should take frequent breaks or change activities as often as possible to avoid longstanding compression which can lead to progression of CTS symptoms.
Because inflammation is the underlying cause in many patients with CTS, foods typically linked to inflammation can be minimized or eliminated to manage symptoms. Sugar, other refined carbohydrates, and fried foods are commonly associated with increased inflammation.
Nutritional supplements can help early/mild CTS, but seldom reverse moderate and severe CTS. Turmeric and other herbal/homeopathic anti-inflammatory supplements can potentially offer some symptom relief, but as with any supplements, please discuss with your doctor before taking them. Vitamin B6 is also thought to help with nerve health and nerve recovery. And it could be considered for patients being treated with conservative measures and night splinting (to prevent prolonged periods of wrist flexion – a common sleeping position) and behavioral/activity modifications as noted above.
Although Carpal Tunnel Syndrome is a common and often painful condition for millions of Americans, it is a very treatable condition, especially when identified in its early stages. Whether by non-surgical or surgical methods, CTS isn’t something that anyone should live with, especially since it can cause irreversible damage to nerves down the road. If you or someone you know is dealing with chronic wrist or hand-related symptoms of pain, numbness, or tingling, make sure to have it looked at right away so you can get on the road to recovery.