Most people think carpal tunnel syndrome (CTS) is a condition caused by long hours of computer keyboarding. But that is just a misconception. Evidence of people experiencing sign and symptoms are well documented back to the beginning of the 20th century.

The carpal tunnel receives its name from the 8 bones in the wrist, called carpals that form a tunnel like structure. This tunnel protects a main nerve (median nerve) to your hand and nine tendons that bend your fingers. Pressure placed on the nerve produces the numbness, pain and, eventually, hand weakness that characterize carpal tunnel syndrome. It is one of the most common disorder and most people have a friend or family member who has CTS. Carpal tunnel syndrome (CTS) has long been regarded in the medical community as a “simple problem” and sometimes just as “annoyance” and unfortunately there have been very few comprehensive publications in medical literature to clear up some of the misinformation that surrounds carpal tunnel syndrome.

What are the Symptoms of CTS?

The symptoms of CTS often first appear as painful tingling in one or both hands during the night, frequently painful enough to disturb sleep. Carpal tunnel syndrome typically starts gradually with a vague aching in your wrist that can extend to your hand or forearm. Other common carpal tunnel syndrome symptoms include tingling or numbness in your fingers or hand, especially your thumb, index, middle or ring fingers, but not your little finger. In advanced cases, muscle at the base of the thumb atrophies and could cause a sense of weakness in your hand and tendency to drop objects. You many also see signs of pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after repetitive use. This usually occurs on palm side of your forearm. Many patients with CTS are unable to differentiate hot from cold by touch, and experience an apparent loss of strength in their fingers. They appear clumsy in that they have trouble performing simple tasks such as tying their shoes or picking up small objects.

Some other health conditions including rheumatoid arthritis, certain hormonal disorders — such as diabetes, thyroid disorders and menopause — fluid retention due to pregnancy, or deposits of amyloid, an abnormal protein produced by cells in your bone marrow can also contribute to CTS.

Risk Factors

Some studies suggest that carpal tunnel syndrome can result from overuse or strain in certain job tasks that require a combination of repetitive, forceful and awkward or stressed motions of your hands and wrists. Examples of these include using power tools — such as chippers, grinders, chain saws or jackhammers — and heavy assembly line work, such as occurs in a meat packing plant. Although repetitive computer use is commonly assumed to cause carpal tunnel syndrome, the scientific evidence for this association isn't definitive.

Although it's not clear which activities can cause carpal tunnel syndrome, if your work or hobbies are hand-intensive — involving a combination of awkward, repetitive wrist or finger motions, forceful pinching or gripping, and working with vibrating tools — you may be at higher risk of developing the condition.

Other risk factors include:

Your sex. Women are three times as likely as men are to develop carpal tunnel syndrome. The incidence in women peaks after menopause, and the risk of carpal tunnel syndrome also increases in men during middle age.

Heredity. You may be significantly more likely to develop carpal tunnel syndrome if close relatives have had the condition. Inherited physical characteristics, such as the shape of your wrist, may make you more susceptible.

Certain health conditions. Conditions including some thyroid problems, diabetes, obesity and rheumatoid arthritis can increase your risk. Women who are pregnant, taking oral contraceptives or going through menopause also are at increased risk, most likely due to hormonal changes. Fluid retention may be a cause of carpal tunnel syndrome during pregnancy. Fortunately, carpal tunnel syndrome related to pregnancy almost always improves after childbirth. People who smoke cigarettes may experience worse symptoms and slower recovery from carpal tunnel syndrome than nonsmokers do

How Large a Problem is CTS?

In the past ten years, more and more cases of workers afflicted with CTS have been reported in medical literature. One reason for this increase may be that automation and job specialization have fragmented workers' tasks to the point where a given job may involve only a few manipulations performed thousands of times per workday. Increased awareness of work-related risk factors in the onset of CTS is reflected in the growing number of requests for health hazard evaluations (HHEs) received by NIOSH to investigate such suspected problems. NIOSH received about three times as many HHE requests related to hand and wrist pain in 1992 as compared to 1982.

Prevention

NIOSH recommendations for controlling carpal tunnel syndrome have focused on ways to relieve awkward wrist positions and repetitive hand movements, and to reduce vibration from hand tools. NIOSH recommends redesigning tools or tool handles to enable the user's wrist to maintain a more natural position during work. Other recommendations have involved modified layouts of workstations. Still other approaches include altering the existing method for performing the job task, providing more frequent rest breaks, and rotating workers across jobs. As a means of prevention, tool and process redesign are preferable to administrative means such as job rotation. The frequency and severity of CTS can be minimized through training programs that increase worker awareness of symptoms and prevention methods, and through proper medical management of injured workers.

Treatment

A nerve test is done to confirm the diagnosis. Once the patient has been diagnosed with carpal tunnel syndrome, a decision verses treatment must be made. One must keep in mind what is going on with the nerve. The nerve is being squeezed. If one has a wedding band on the ring finger and the hand is crushed between two objects, then the entire hand begins to swell and the ring acts as a tourniquet cutting off the flow of blood to the finger. It is easy to understand that the ring has to be cut off the finger or else the finger will die. Likewise the nerve is being pinched. The nerve fibers are being pinched and they will be deprived of blood flow and undergo irreversible changes and ultimately die unless the pressure is released before those irreversible changes take place. Treatment of CTS may involve surgery to release the compression on the median nerve and/or use of anti-inflammatory drugs and hand splinting to reduce tendon swelling in the carpal tunnel. Such medical interventions have met with mixed success, especially when an affected person must return to the same working conditions. Thus the goal of treating carpal tunnel syndrome is not simply to reduce the pressure on the nerve so that the symptoms are tolerable and the patient can live with it but rather to alleviate the pressure entirely.

Waiting “until it gets too bad” is not advised and one may actually end up with permanent nerve damage. Make no mistake; carpal tunnel is big business. There are thousands of gimmicks and gadgets trying to prevent carpal tunnel, treat carpal tunnel, and avoid surgery. On the other hand, physicians are eager to perform a surgery on your hand and make quick bucks.

What works and what doesn't may depend on the length of time you have had this condition. I have known people who have had surgery done and still have the symptoms. On the other hand, I know people who did hand exercises and got rid of the symptoms.

But in all cases, exercise may only work if your symptoms are recent (6 - 12 months). Once you have had it for longer, surgery might be the only option and sometimes it might even make it worse.