CARPAL TUNNEL SYNDROME:
WHAT IT IS AND WHAT TO DO ABOUT IT
October 22, 2002, Warrenville, IL -
Carpal Tunnel Syndrome (CTS) is a term commonly used by
patients to describe symptoms associated with the hand
and arms. There is also a perception
that only people who perform repetitive work or use keyboards
would get the condition. Approximately 260,000 operations
are performed to treat CTS each year. About half of the
cases are considered work-related.
The term describes a condition where there is compression
of a specific nerve (median nerve) at the level of the
wrist. The nerve lies in an area of the wrist called the
carpal tunnel. People who have the condition tend to have
increased pressure within the carpal tunnel, resulting
in a compression of the nerve. Simple daily activities
such as pushing an object or making a fist can cause an
increase in the pressure.
The function of the median nerve is to provide sensation
to part of the hand and also to allow certain motion of
the fingers. When the nerve feels "pinched,"
a person can experience a variety of symptoms: weakness
or clumsiness in the hand, altered sensation or loss of
sensation in the hand, pain with use such as during grasping,
numbness and tingling would would awaken the person in
the middle of the night. The pain can also radiate to
the elbow or even the shoulder. The symptoms can become
noticeable while holding newspapers or the steering wheel
of a car.
Carpal Tunnel Syndrome accounted for 1.7 percent of work-related
conditions in private industry in 1994, based on data
from the Bureau of Labor Statistics. The cases were present
more commonly in the area of manufacturing and retail.
About forty-seven percent of the CTS cases resulted in
thirty-one days or more of work loss.
Medical conditions that can be associated with increased
rate of CTS include rheumatoid arthritis, diabetes, thyroid
dysfunction, and trauma to the wrist. Pregnancy can also
lead to CTS in both wrists.
Initial treatments consist of wearing a splint at night,
and use of anti-inflammatory medications (NSAID) such
as ibuprofen or prescription-strength NSAID. Physical
and occupational therapy may also provide relief of symptoms.
If these noninvasive treatments do not provide relief
or if the condition is somewhat advanced at the time of
presentation, a steroid injection can be performed.
If the condition persists in spite of these non-surgical
treatments, surgery can be done to relieve the pressure
on the nerve. The surgery is done on an outpatient basis
and usually requires local anesthetic only with or without
intravenous sedation. After surgery, the patient may experience
immediate relief. Pain tends to improve before the numbness
and tingling sensation. Recovery of strength tends to
be a long process. It may take about six months or more
before the grip strength as well as the endurance return
fully. In general, seventy-five percent of the strength
returns after about eight to ten weeks.
To prevent CTS, certain exercises for the arms and hands
can be performed. The team of orthopaedic surgeons who
develop them suggests that they be performed at the start
of each work shift and also after each break. Workstations
can also be examined and adjusted to accommodate a person.
For further information on carpal tunnel syndrome, contact
the American Academy of Orthopaedic Surgeons online at
www.aaos.org.
This article was written by Mary Ling, M.D., orthopaedic
surgeon and hand specialist at Hand Care Associates, a
division of OAD Orthopaedics, Ltd. For further information,
call Hand Care Associates at (630) 225-2424 or OAD Orthopaedics
at (630) 225-BONE(2663). OAD Orthopaedics (OAD) is a comprehensive
orthopaedic clinic with expertise in hand care, spinal
surgery, rehabilitation, sports medicine, adult orthopaedics
and workers' compensation. With sixteen orthopaedic specialists,
OAD has offices in Warrenville, Wheaton, Naperville and
Carol Stream.
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