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Carpal Tunnel Syndrome (CTS)

What is Carpal Tunnel Syndrome (CTS)?

Carpal Tunnel Syndrome is caused by compression of the median nerve that passes through the wrist. It is a narrow passageway surrounded by wrist bones and tendons on the palm side of the hand and roofed by transverse ligament. When tendons get swelling or thickening, that compresses the nerve, it can cause tingling, numbness, weakness in hands and limited range of motions. 

Anatomy

The median nerve runs from the spine to the upper arm, elbow, forearm, to the tunnel in the wrist then to hand and fingers. It functions to transfers sensation of touch from the thumb, index, middle fingers, and half of 4th finger, while it moves parts of hand muscles at the same time. 

Carpal tunnel is very narrow space in the wrist, where nine tendons travels through as well that flex (bend) the fingers and thumb. 

Examination

– Simple examination such as pressing down or tap along the nerve pass-way on the palm side of your wrist and hand. Tingling sensation, numbness means positive

– Bend and hold both wrist against each other to test worsening of presenting symptoms in the hands means positive

– Test hand sensitivities in thumb, index, and middle fingers to compare with other fingers or hand while eyes are closed

– Smaller size of thumb or weakness of muscles around the thumb or fingers. 

If one or more of test above applies to you, it is recommended that you see health practitioner. 

How is it treated?

If symptoms are mild, it is recommended to wear a brace or splint. Wearing supportive equipment at night can help to straighten the wrist to reduce the pressure in the carpal tunnel. You could wear it during the day if any activities required involves repetitive usage of the wrist. Otherwise, you will be given exercises or anti-inflammatory drugs. 

With acupuncture needles, it will be given on local area or on the neck if symptoms are mild to reduce the tensions in the neck, upper arm, elbow or wrist or other points to reduce fluid retention. You may also be given with electric stimulation like Transcutaneous Electrical Nerve Stimulation (TENS) machine to strengthen the nerves.  

Sometimes, Chinese herbs may be prescribed not only to relieve symptoms, but also to treat unbalanced internal organ that may contribute carpal tunnel syndrome.

What are the Symptoms?

The most common symptoms of CTS are:

– Tingling or numbness in fingers or palm side of the hand (some describes as pins and needles) more in the thumb, index, middle and half of 4th fingers

– Nerve pain in the wrist or hand or even to your arm

– Weakness in affected hand that may lead to dropping object from the hand

– Swelling in the wrist or fingers. 

It can happen on both sides but doesn’t transfer from one side another. However, if untreated for long period of time, it can affect other side of the hand due to compensation. 

What causes it?

Carpal tunnel syndrome can be caused by increased pressure on the median nerve. This includes:

– Heredity- some people tends to have narrower carpal tunnel space than the others

– Repetitive sprain or fracture leading to thickening of tendons

– Repetitive use of wrist/ hand

– Rheumatoid arthritis or joint disorders

– Tendonitis

– Increased fluid retention during pregnancy or menopause

– A cyst or tumor in the local area

– Diabetes

– Acromegaly (abnormal growth of the hand)

– Person with kidney disease undergoes dialysis

How can I prevent it?

No such methods are proven to stop carpal tunnel syndrome, but you can minimize the stress on the wrist and hands by following:

– Reduce the force applied to the wrist and hands such as changing size of pen, hitting the keyboards softly.

– Frequent breaks between the work. Stretching hands by bending both ways can help to stretch tensioned muscles and tendons and increase the circulation on the wrist.

– Posture. Try adjusting position of keyboard below or slightly lower than your elbow while fingers positioned middle. Rounded shoulders crouched back can worsen your symptoms. If this you while reading this, try straightening your lower back, straighten the mid-back and widen your shoulders broad.

– Changing to ergonomic mouse can help to prevent work-related carpal tunnel, otherwise it will keep coming back. 

– Most importantly, try keep your hands, wrist, elbow warm. You probably have read above or from somewhere else, but WHY elbow? This is because elbow is where all nine tendons’ attachments start from and treating muscle attachment could relieve from ten to fifty percent of your symptoms.