That tingling or burning in your thumb and index finger; the occasional weakness you notice when you hold a cup-this may not be a hand problem at all. Carpal tunnel syndrome is the most common nerve entrapment and involves the wrist.

That tingling or burning in your thumb and index finger; the occasional weakness you notice when you hold a cup-this may not be a hand problem at all. Carpal tunnel syndrome is the most common nerve entrapment and involves the wrist.



What do you know?

1. Neck problems can cause carpal tunnel syndrome.

2. Three times as many women are affected as men.

3. Compression at the elbow can cause carpal tunnel syndrome.

Carpal tunnel syndrome is caused by compression on the median nerve at the wrist, one of three main nerves going to the hand for sensation and muscle activation. The median nerve courses under a fibrous band of tissue. Think of driving through a tunnel. When the fibrous band becomes inflamed or thickened the nerve can be compressed. The result of this can be mild to severe numbness or weakness of the thumb, index and middle finger.  At first, the symptoms are mild but over time typically worsen.

There are several causes for CTS including genetic predisposition and medical conditions. Those whose jobs or hobbies involve repetitive movement and assembly line work seem to be at higher risk. Worksite analysis is important because some minor changes in how a task is done may yield some relief.

Not all tingling or weakness is CTS. Nerve compression at any location can cause tingling or weakness. It is important to determine the specific site of the compression for proper management. Compression of nerves at the neck, elbow, forearm and wrist can be assessed with electromyogram or nerve conduction study. These may be recommended to aid in diagnosis.

Braces are used to stretch the band and prevent further compression at the wrist. Often we sleep with hands and wrists curled inward. This position compresses the carpal tunnel often leading to night pain. Braces are designed to “cock-up” the wrist, open the carpal tunnel and prevent compression. Worn at bedtime, braces may make a big difference with symptoms and sleep. Worn during the day, they may lessen symptoms enough to allow for work and play. Braces can be obtained through your physician and at pharmacies. Non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen and corticosteroids are often used in treatment.

 Physical therapy directed at stretching the fibrous band and alleviating pain may be helpful. Surgery to cut the fibrous band and open up the tunnel to relieve pressure on the median nerve is highly successful. Following surgery referral to a hand therapist is common to optimize outcome.

Do not ignore nerve symptoms. Contact your physician for a full investigation. For information from the National Institutes of Health go to www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm. Lift your cup with confidence!



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