Carpal Tunnel: Step into the light

Carpal Tunnel

Oh My God otherwise known as OMG. What the hell is this pain?  Carpal tunnel or Carpal tunnel syndrome or CTS can be an incredibly distressing condition ranging from mild pain and discomfort to extreme pain, numbness and loss of function of the  fingers, hands and even arms not to mention what the hell is this?

You don’t have to stay in the dark with carpal tunnel syndrome. We are here to help.

What is Carpal Tunnel?

So what is it then? Carpal tunnel syndrome is a condition where the median nerve which allows sensation and movement of the hands and fingers becomes impinged affecting both of these functions. The carpal tunnel is formed by the wrist bones and the transverse carpal ligament and is designed to protect the median nerve from damage. This tunnel is rather small and does not have the capacity to expand with pressure.

The issue occurs when the 9 tendons which connect to the hand and travel through the carpal tunnel become swollen or the tunnel itself narrows. As there is little ability for expansion excessive swelling or loss of space can result in the median nerve becoming impinged creating tingling, numbness and pain, Butit what does it mean?

What are the symptoms of Carpal Tunnel?

Symptoms of CTS generally affects the index, middle and ring finger as well as the thumb and may include:

  • Sporadic electric shock type sensations that radiate to the hand and fingers.
  • Burning pain
  • Numbness, tingling and pins and needles
  • General ache
  • Pain or tingling that may travel up the forearm
  • Weakness of the hand
  • Decreased hand co-ordination

The symptoms of CTS often begin gradually without any obvious injury. The symptoms may also be inconsistent in the early stages. However as time goes on the symptoms generally get worse and more consistent. So why?

What causes Carpal Tunnel?

Most cases of CTS are caused by a combination of factors which may include:

  • Genetics – a smaller carpal tunnel requires less inflammation or narrowing to impinge the median nerve meaning symptoms are easier to develop and harder to treat..
  • Pregnancy – hormonal changes during pregnancy can result in general swelling that can affect the wrist.
  • Repetitive hand activity – CTS seems to be more common in people who engage in repetitive tasks using their hands. Repeated activity can lead to inflammation of the wrist tendons causing swelling within the carpal tunnel and aggravating the median nerve.
  • Poor hand and wrist position – excessive flexion or extension of the wrist can increase the pressure on the tendons and the median nerve creating aggravation and swelling.
  • Autoimmune conditions – including rheumatoid arthritis, diabetes and other conditions that result in excess inflammation and swelling that can affect the wrist and other parts of the body

Lack of activity or excessive activity commonly increase symptoms. Symptoms quite often become worse at night affecting sleep or with repetitive activity such as computer work, device scrolling or holding objects for long periods

How is CTS diagnosed?

Physical tests including:

  • Finger sensitivity test
  • Flexing the wrist to test for symptoms
  • Tinel sign – tapping median nerve to test for symptoms
  • Muscle atrophy
  • Physical weakness
  • Nerve conduction tests which measure nerve signals
  • Electromyogram (EMG) tests electrical activity in muscles
  • Ultrasound to look for median nerve compression or other tissue changes
  • X-ray to check for any structural anomaly
  • MRI

How is CTS treated?

If diagnosed and treated early, the symptoms of CTS can often be relieved without surgery.

Nonsurgical treatments may include:

  • Splinting – helps to keep the wrist in a neutral position and reduce the pressure within the carpal tunnel.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – These medications are used to reduce pain and inflammation. However there are risks associated with such medication which you can find more about here.
  • Avoiding repetitive activity to allow the inflammation and swelling to subside.
  • Regular position changes reduce aggravation which occurs when the hand and wrist are in the same position for too long.
  • Steroid injection into the carpal tunnel may relieve symptoms for a period of time.
  • Nerve gliding exercises may assist the median nerve to move more freely.

 Surgical intervention for CTS

If nonsurgical efforts do not  relieve symptoms surgery may be recommended.

The procedures performed for carpal tunnel syndrome are called  “carpal tunnel release.” Both methods, open carpal tunnel release and endoscopic carpal tunnel release, aim to reduce pressure on the median nerve by cutting or dividing the transverse carpal tunnel ligament.

Can acupuncture help Carpal Tunnel?

Acupuncture as a general treatment has been shown in numerous studies to have a strong effect in the management of pain. As pain and inflammation are the major drivers of CTS acupuncture may be an effective strategy to assist with symptoms associated.

A systematic review of randomised double blind control trials (1) totalling 728 participants found acupuncture to be superior to the use of NSAIDS in reducing the pain associated with CTS. It was also found to be more effective in symptom management and motor function improvement when used in conjunction with splinting rather than splinting alone.

Another randomised double blind control trial (2) found acupuncture and splinting to be significantly more effective in reducing pain and improving motor function than splinting and supplementation of B1 and B6 alone.

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References

  1. Acupuncture and related interventions for CTS: systematic review Irene XY Wu,Victor CK Lam, Robin ST Ho, William KW Cheung, Regina WS Sit, Li-Wei Chou, Yan Zhang, Ting-Hung Leung, Vincent CH Chung First Published September 26, 2019
  2. Acupuncture in treatment of CTS: A randomized controlled trial study Saeid Khosrawi1, Alireza Moghtaderi, Shila Haghighat Res med Journal 2012