Sept. 7, 2009 | Somewhere between four and 10 million people in the U.S. suffer from carpal tunnel syndrome. According to the Bureau of Labor Statistics, people with the condition missed an average of 28 days of work, making it second among major disabling diseases and illnesses in all private industries. Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel, a narrow passageway of ligament and bones at the base of the hand, houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain or numbness in the hand and wrist, radiating up the arm.

Sept. 7, 2009 | Middle-aged to older individuals are more likely to develop carpal tunnel syndrome than younger persons, and women are three times more likely than men to develop the condition due to the fact that the carpal tunnel itself is smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body’s nerves and make them more susceptible to compression are also at high risk. The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but it is especially common in those performing assembly line work, such as meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. A 2001 study by the Mayo Clinic found that heavy computer use, up to 7 hours a day, did not increase a person’s risk of developing carpal tunnel syndrome.

Sept. 7, 2009 | Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition, the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as a sprain or fracture, an overactive pituitary gland, fluid retention during pregnancy or menopause, repeated use of vibrating hand tools or the development of a cyst or tumor in the canal. In some cases, no cause can be identified. There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities cause carpal tunnel syndrome. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis.

Sept. 7, 2009 | Usually, carpal tunnel syndrome affects only one hand, but it can affect both at the same time, causing symptoms in all or some of the fingers including thumb, index, middle and adjacent half of the ring finger but rarely the little finger. In addition to numbness, those with the syndrome may experience tingling, pins and needle sensation or burning of the hand occasionally extending up the forearm. Frequently, symptoms surface in the morning upon awakening, or may cause waking during the night. Symptoms can occur with certain activities such as driving, holding a book or other repetitive activity with the hands, especially those requiring prolonged grasping or bending of the wrist. Hand functional activities, such as buttoning, may become difficult, and sufferers may drop things more easily. Individuals often shake their hands trying to obtain relief and may experience the sensation of swelling when, in fact, no swelling is actually present.

Sept. 7, 2009 | Medication such as nonsteroidal anti-inflammatory drugs can be used for relief of carpal tunnel syndrome. Splinting the wrist, especially at night, helps keep the wrist straight during the night and thus decreases the pressure on the median nerve. These splints usually relieve symptoms, especially in milder cases. A cortisone injection into the carpal tunnel area is often helpful in relieving symptoms for weeks to months and can be repeated. If there is an underlying disease, such as hypothyroidism or rheumatoid arthritis, causing the carpal tunnel syndrome, then treatment of the specific disease may also relieve symptoms. When the above measures fail to relieve symptoms, surgically opening the tunnel to relieve the pressure on the median nerve, known as a carpal tunnel release, is done. In severe cases, early surgery may be considered. The surgery may be an open surgical procedure or an endoscopic procedure, and can be often done on an outpatient basis.