Oh My Aching Hand! A look at Carpal Tunnel Syndrome
May 14, 2004
The Bottom Line Numbness? Tingling? Pain?? It may be Carpal Tunnel Syndrome.
A lot of people come up to me and complain about their aching hand/arm. They tell me it hurts because they must have Carpal Tunnel Syndrome. Sometimes their doctor may diagnose them for CTS and they are afraid of what it means: possible surgery.
As a hand therapist, I treat hundreds of people a year with this thing called Carpal Tunnel Syndrome. Sometimes it turns out to be CTS and sometimes it isn't. How can you tell? Most times the average person does not know what CTS is except for the symptoms: pain, numbness and tingling.
There are thousands of pages on the web about CTS so I will condense everything down for the layman and explain it in easy-to-understand English, in very simplistic terms.
DISCLAIMER: I am not responsible for anything I write here. You are reading at your own risk and you should always check with a medical doctor.
BASIC NERVE ANATOMY OF THE HAND:
The hand is a very complex part of your body. I won't even try to go into the details of the structure of the hand. It took me over ten years to learn the hand and I am still learning! Just for the sake of simplicity, let's talk about the nerve.
The nerves in the human body (including the hand) is responsible for sensation (hot, cold, pain, pressure, light touch, etc) and powering the muscles for movement. If you put pressure on the nerve, guess what happens? Its like kinking a water hose...the water just barely trickles out. Same with the nerve. If you smash it and kink it up, it won't be able to function properly. Nerves do not contain liquid like a water hose, but it does carry signals from the muscles to the brain and vice versa. Kink the "wire" and you have a lot of problems.
In CTS, the nerve gets smashed up inside the wrist, in the carpal tunnel, hence the name. It gets its name because the area that the nerve travels in is very narrow, like a tunnel. The floor of the tunnel are the carpal (hand) bones and the roof of the tunnel is a thick band of ligament called the transverse carpal ligament. Now, with such a narrow space, you can see how easily it is to smash this nerve, or, if you want to picture it, kink a water hose.
HOW THE NERVE GETS SMASHED UP:
This nerve inside your wrist that is traveling through the narrow tunnel is called the Median nerve. It goes to your thumb, index finger, middle and half of the ring finger. When this nerve gets smashed, you will know it!
For the sake of simplicity, let's assume that your nerve is smashed in the wrist (the most common location). Sometimes it is not smashed in the wrist, but rather in the forearm, in your elbow or in your spine. But just for this discussion, let's say it is a pure CTS. You have been diagnosed by your doctor and he/she tells you that it is your wrist that is the problem.
How did this happen?
There are many, many factors! But again, for the sake of being a simple primer, let's just list the most common causes of nerve compression:
1) your work =
do you use the keyboard a lot? Do you use a lot of repetitive motions for your job like working on an assembly line? Does your job require you to grab items and hold them for long periods of time? Bend your wrist constantly? Are you in an awkward position and working in tight spaces (auto mechanic, dentist, plumber, etc)? Do you use a lot of force (construction)? Do you use vibrating tools? Are you in a cold environment (meat cutters, factory workers, etc)?
As you can see, your work can be the primary source of nerve irritation and/or compression.
2) your hobbies =
are you on the computer a LOT? Do you knit? Crochet? Sew? Windsurf? Bowl? What kinds of hobbies do you like to participate in? Hobbies usually are not solely to blame for causes of CTS (unless you are a computer addict like me ;-) but can aggravate existing problems.
3) your current health =
the risks for CTS include pregnancy, swelling of hand or arm via chemotherapy or IV drugs, diabetes, obesity, arthritis, fractures (old or new) of the wrist or hand, hypothyroidism, trigger fingers among others. The ones I have listed are the most common causes.
Women who are pregnant or have delivered usually have relief of the symptoms when the swelling goes down.
Numbness and tingling, especially in the thumb, index, middle and sometimes ring finger are the first signs of CTS. Usually, but not always will a patient exhibit numbness and tingling. Patients complain of the "hand falling asleep" and the need to shake out the hand. Sleep is sometimes disrupted, with patients waking up frequently throughout the night.
Pain in thumb area, wrist or forearm. Pain can be characterized as "burning", "aching", "tiredness" or "throbbing" may be reported.
Impaired circulation can cause the patient to complain of symptoms like the hand feeling "cold" or "frozen".
HOW IS A DIAGNOSIS MADE?
Your doctor will make the diagnosis of CTS. There are a variety of tests that the doctor can do on your hand besides just listening to your symptoms.
Tinel's Sign - your doctor may tap your wrist to see if you get the "zinging" sensation that is tell-tale of nerve compression.
Phalen's Test - your doctor may have you bend your wrists to purposely smash the nerve in the tunnel to see if you have an increase in symptoms.
EMG - the doctor may do an electromyogram on your hand/arm to see where the nerve is smashed. He/she uses electrodes/needles to shock your hand or arm to see how fast your muscles react to the currents.
Most likely though, the diagnosis is made solely by patient complaint.
Some doctors will order therapy (physical or occupational therapy PT/OT) or nothing. They may issue a wrist support brace and tell you take some anti-inflammatory medications and see if you get better. Sometimes you may get a cortisone shot. In the cases of severe nerve compression, you will need to have surgery.
If you are sent to a PT or OT, they will do a complete exam of your hand by testing your grip and pinch strength, your wrist bending measurements, take a look at your muscles, your arm and in some cases your neck or spine. If you are lucky enough to be seen by a therapist who is also an ergonomist, this therapist will do a complete analysis of your work demands, your workstation set up, your hobbies, etc.
The therapist may do postural training, splinting, massages, ultrasound and iontophoresis drug treatments, stretches, and sometimes actually come out to your work to look at your computer set up (if that is the kind of work you do).
If nothing helps and your nerve compression is moderate to severe, you may need to have surgery. The doctor may do the surgery herself, or refer you out to a surgeon. It is usually an outpatient surgery where you are still awake in the doctor's office. Your arm is numbed and then operated on. Most doctors will not let you watch. Some doctors will ask you if you are interested. It takes about 30 minutes and the roof of the carpal tunnel is snipped in half to relieve the pressure on the nerve. The incision is then sewed up and you may be placed in a splint to rest the hand for about 2 weeks.
Recovery is usually within 6-8 weeks. You may be sent to therapy to do hand exercises, desensitization of the scar tissue and scar management. If not, your doctor may just follow up with you to make sure you are healing OK without complications.
RELATED HAND/ARM PROBLEMS:
Besides CTS, the other more common diagnoses are DeQuervain's Tenosynovitis (pain along the thumb side and making thumb/wrist motions toward the thumb), Cubital Tunnel Syndrome (smashed ulnar nerve in elbow), ulnar nerve smashed up in hand on pinkie side (pinkie and ring fingers go numb), trigger finger (finger snaps or "catches" and "locks up").
I will write more articles in the future regarding how to choose a good doctor and how to work with your therapist.
Thanks for reading! I must get off the computer now. my hand is swelling up from all this typing and the salty food I ate.