Carpal Tunnel Syndrome: Navigating the Path to Relief

As technological advancements continue to reshape our world, the intricate tapestry of human disorders has woven itself into new patterns, reflecting the ever-changing challenges of our digital age. Carpal tunnel syndrome, otherwise known as CTS, was first described in the mid 1800s, which is around the time period when the first digital computer was developed. This syndrome serves as a compelling illustration of how modern technological advancements, particularly prolonged computer usage and repetitive keyboard activities, can contribute to the emergence of musculoskeletal disorders.

The carpal tunnel, as implied by its name, is essentially a passageway connecting the median nerve and tendons to the hand and forearm. Carpal bones makeup the bottom and sides of the “tunnel”, and the ligament is the top of the “tunnel”, holding everything together. Connected by the carpal tunnel, the median nerve, which is crucial to CTS, allows fingers except the pinky to feel and adds strength to the thumb and index fingers. To add on, tendons connect muscles in the forearm to the bones in the hand. So, what exactly is carpal tunnel syndrome? It is a common neurological disorder caused by narrowing of the carpal tunnel, pressing down on the median nerve and tendons. Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to CTS, and this syndrome is typically not developed by a single reason but by a combination of risk factors.

A common myth regarding CTS is that the disorder only affects office and factory workers. In reality, although it often does affect office and factory workers, CTS can affect anyone who repeatedly uses their wrists and hands. The syndrome is more prominent in people older than 20 years old, as the chance of getting CTS increases with age. Women are three times more likely than men to develop CTS, and it has been discovered that most women diagnosed tend to have smaller carpal tunnels. Less severe CTS can also be genetic, running in families, but ultimately those who do activities or jobs involving repetitive finger use are at utmost risk.

The symptoms of CTS gradually worsen over time, and the dominant hand is usually affected first as it experiences more severe symptoms. Early symptoms include numbness at night, which is often the first reported symptom among CTS patients. This numbness often wakes patients up at night, but can often be relieved by shaking the hand. Another common symptom in the early stages of CTS is tingling or pain in the fingers, especially in the thumb, index, and middle fingers. As the disease advances beyond its initial stages, typical daytime symptoms become increasingly noticeable, including tingling or numbness that can radiate from the wrist up the arm, reduced sensation in the fingers, and challenges in performing small tasks such as typing on a keyboard, grasping objects, and gripping the steering wheel while driving. Over time, the hand also demonstrates noticeable weakness, shown by inability to execute delicate tasks, frequent dropping of objects due to a lack of grip, and, in the most severe cases, muscle shrinkage at the base of the thumb is visibly evident.

When a patient exhibits symptoms suggestive of CTS, various medical examinations are available to aid in the diagnosis. A physical exam is usually done first, along with laboratory tests and x-rays. Then, specific wrist tests are performed, such as the Tinel test, involving tapping or pressing on the median nerve by a physician, and the Phalen test, where the patient holds their forearms upright with fingers pointing downward and presses the backs of their hands together—the presence of tingling or numbness indicating CTS. Furthermore, electrodiagnostic tests are also used, including the nerve conduction study, where the speed of nerve impulse transmission is assessed, and electromyography, where a fine needle is inserted into a muscle to assess electrical activity and determine the extent of damage to the median nerve. Diagnostic imaging, such as ultrasound imaging, is occasionally utilized to reveal the abnormal size of the median nerve, aiding in the diagnosis of CTS.

Following the diagnosis of the syndrome, there are two primary approaches to its treatment: non-surgical and surgical interventions. Non-surgical treatment is typically recommended for less severe cases and includes wearing a wrist splint at night, taking non-steroidal anti-inflammatory drugs (with ibuprofen being the most common choice), and receiving corticosteroid injections to reduce swelling in the connective tissue, thus alleviating pressure on the median nerve. Symptoms can also be decreased by changes to the environments of the patients, such as chair height, computer keyboard placement, hand and wrist position while completing activities, and more. Exercises recommended by a hand therapist can also be helpful at times. Conversely, surgery is recommended in more severe cases when non-surgical treatments prove ineffective. The goal of surgical treatment is to enlarge the carpal tunnel, resulting in decrease of pressure on the median nerve and tendons. During the surgery, the transverse carpal ligament, which is the ligament covering the carpal tunnel, is cut at the base of the palm. CTS surgery has extremely positive outcomes, with a success rate of 90%. The treatment of CTS offers a spectrum of options, ranging from non-surgical interventions tailored to milder cases to surgical procedures, with surgery boasting a remarkable success rate in relieving symptoms and improving patients’ quality of life.

CTS is the most common form of entrapment neuropathy, affecting roughly 3-6% of the adult population, largely owing to its challenging prevention, given its potential association with a wide range of activities and contributing factors. Nonetheless, there are preventive measures to reduce the risk of developing the syndrome, such as modifying the workplace environment, maintaining straight wrist positions during sleep and tool usage, minimizing repetitive wrist movements, incorporating regular breaks during repetitive hand and wrist activities, enhancing posture, and engaging in hand and wrist stretching exercises. Presently, extensive research is underway in the field of CTS, with a focus on investigating the biomechanical stressors that lead to nerve damage and subsequently give rise to the symptoms associated with CTS. Additionally, effects of acupuncture on pain and loss of median nerve function and effectiveness of osteopathic manipulative treatment in conjunction with standard medical care are being investigated. The U.S. Department of Health and Human Services has also noted continued research into tissue damage linked to repetitive motion disorders, including the development of animal models to better comprehend and characterize connective tissue, with the ultimate goal of mitigating harmful tissue accumulation and identifying novel treatment approaches.

Carpal tunnel syndrome is a significant and prevalent disorder in the modern world, affecting a substantial portion of the adult population. With its multifaceted impact on individuals’ daily lives, there is a compelling need for ongoing research to better understand and mitigate the condition, ultimately improving the quality of life for CTS patients through enhanced preventive measures and innovative treatment strategies.

Works Cited

Cleveland Clinic. (2019, October 2). Carpal Tunnel Syndrome. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4005-carpal-tunnel-syndrome.

Joshi, A., Patel, K., Mohamed, A., Oak, S., Zhang, M. H., Hsiung, H., Zhang, A., & Patel, U. K. (2022). Carpal Tunnel Syndrome: Pathophysiology and Comprehensive Guidelines for Clinical Evaluation and Treatment. Cureus, 14(7), e27053. https://doi.org/10.7759/cureus.27053

Mayo Foundation for Medical Education and Research. (2022, February 25). Carpal tunnel syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/symptoms-causes/syc-20355603.

U.S. Department of Health and Human Services. (n.d.). Carpal Tunnel Syndrome. National Institute of Neurological Disorders and Stroke.https://www.ninds.nih.gov/health-information/disorders/carpal-tunnel-syndrome#:~:text=Carpal%20tunnel%20syndrome%20(CTS)%20is,may%20become%20swollen%20and%20useless.