Who is at risk of developing carpal tunnel syndrome?

Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be 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. Carpal tunnel syndrome usually occurs only in adults.

The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work - manufacturing, sewing, finishing, cleaning, and 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 heavy computer use (up to 7 hours a day) did not increase a person's risk of developing carpal tunnel syndrome.

During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker.

CTS glossary-part 2

Chronic: This important term in medicine comes from the Greek chronos, time and means lasting a long time. See the entire definition of Chronic
Condition: The term "condition" has a number of biomedical meanings including the following:
An unhealthy state, such as in "this is a progressive condition."
A state of fitness, such as "getting into condition."
Something that is essential to the occurrence of something else; essentially a "precondition."
As a verb: to cause a change in something so that a response that was previously associated with a certain stimulus becomes associated with another stimulus; to condition a person, as in behavioral conditioning.
Diabetes: Refers to diabetes mellitus or, less often, to diabetes insipidus . Diabetes mellitus and diabetes insipidus share the name "diabetes" because they are both conditions characterized by excessive urination (polyuria). See the entire definition of Diabetes
Diagnosis: 1 The nature of a disease ; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies . 3 The identification of any problem. The diagnosis was a plugged IV. See the entire definition of Diagnosis
Disease: Illness or sickness often characterized by typical patient problems (symptoms) and physical findings (signs). Disruption sequence: The events that occur when a fetus that is developing normally is subjected to a destructive agent such as the rubella (German measles) virus. Elbow: The juncture of the long bones in the middle portion of the arm. The bone of the upper arm (humerus) meets both the ulna (the inner bone of the forearm) and radius (the outer bone of the forearm) to form a hinge joint at the elbow. The radius and ulna also meet one another in the elbow to permit a small amount of rotation of the forearm. The elbow therefore functions to move the arm like a hinge (forward and backward) and in rotation (outward and inward). The biceps muscle is the major muscle that flexes the elbow hinge, and the triceps muscle is the major muscle that extends it. The primary stability of the elbow is provided by the ulnar collateral ligament, located on the medial (inner) side of the elbow. The outer bony prominence of the elbow is the lateral epicondyle, a part of the humerus bone. Tendons attached to this area can be injured, causing inflammation or tendonitis (lateral epicondylitis, or tennis elbow). The inner portion of the elbow is a bony prominence called the medial epicondyle of the humerus. Additional tendons from muscles attach here and can be injured, likewise causing inflammation or tendonitis (medial epicondylitis, or golfer's elbow). See also: Elbow bursitis ; Elbow pain ; Nursemaid's elbow. See the entire definition of Elbow
Electromyogram: A test used to record the electrical activity of muscles. When muscles are active, they produce an electrical current that is usually proportional to the level of muscle activity. An electromyogram (EMG) is also called a myogram. See the entire definition of Electromyogram
Extremity: The extremities in medical language are not freezing cold or scorching heat but rather the uttermost parts of the body. The extremities are simply the hands and feet. See the entire definition of Extremity
Foot: The end of the leg on which a person normally stands and walks. The foot is an extremely complex anatomic structure made up of 26 bones and 33 joints that must work together with 19 muscles and 107 ligaments to execute highly precise movements. At the same time the foot must be strong to support more than 100,000 pounds of pressure for every mile walked. Even small changes in the foot can unexpectedly undermine its structural integrity and cause pain with every step. See the entire definition of Foot
Forearm: The portion of the upper limb from the elbow to the wrist. See the entire definition of Forearm
Gastrointestinal: Adjective referring collectively to the stomach and small and large intestines. See the entire definition of Gastrointestinal
Hormone: A chemical substance produced in the body that controls and regulates the activity of certain cells or organs. See the entire definition of Hormone
Hypothyroid: Deficiency of thyroid hormone which is normally made by the thyroid gland which is located in the front of the neck:
Inflammation: A basic way in which the body reacts to infection , irritation or other injury, the key feature being redness, warmth, swelling and pain . Inflammation is now recognized as a type of nonspecific immune response . See the entire definition of Inflammation
Joint: A joint is the area where two bones are attached for the purpose of motion of body parts. A joint is usually formed of fibrous connective tissue and cartilage. An articulation or an arthrosis is the same as a joint. See the entire definition of Joint
Leukemia : Cancer of the blood cells. The growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia). See the entire definition of Leukemia
Median: The middle. Like the median strip in a highway.
Medication: 1. A drug or medicine. 2. The administration of a drug or medicine. (Note that "medication" does not have the dangerous double meaning of "drug.")
Mouth: 1. The upper opening of the digestive tract, beginning with the lips and containing the teeth, gums, and tongue. Foodstuffs are broken down mechanically in the mouth by chewing and saliva is added as a lubricant. Saliva contains amylase, an enzyme that digests starch. 2. Any opening or aperture in the body. The mouth in both senses of the word is also called the os, the Latin word for an opening, or mouth. The o in os is pronounced as in hope. The genitive form of os is oris from which comes the word oral.
Multiple myeloma: A malignancy of plasma cells (a form of lymphocyte) that typically involves multiple sites within the bone morrow and secretes all or part of a monoclonal antibody . Also called plasma cell myeloma.

CTS glossary

Abdominal: Relating to the abdomen, the belly , that part of the body that contains all of the structures between the chest and the pelvis . The abdomen is separated anatomically from the chest by the diaphragm , the powerful muscle spanning the body cavity below the lungs . See the entire definition of Abdominal
Abnormal: Not normal. Deviating from the usual structure, position, condition, or behavior. In referring to a growth, abnormal may mean that it is cancerous or premalignant (likely to become cancer ). See the entire definition of Abnormal
Amyloidosis : A disorder that results from the abnormal deposition of a particular protein, called amyloid, in various tissues of the body. Amyloid protein can be deposited in a localized area, and not be harmful, or in can cause serious changes in virtually any organ of the body. See the entire definition of Amyloidosis
Analogous: In anatomy, similar in appearance or function but otherwise different. Two structures may be analogous if they serve the same purpose but differ evolutionary in origin as, for example, human and insect legs. As compared to homologous.
Analysis: A psychology term for processes used to gain understanding of complex emotional or behavioral issues. See the entire definition of Analysis
Anatomy: The study of form. Gross anatomy involves structures that can be seen with the naked eye. It is as opposed to microscopic anatomy (or histology) which involves structures seen under the microscope. Traditionally, both gross and microscopic anatomy have been studied in the first year of medical school in the U.S. The most celebrated textbook of anatomy in the English-speaking world is Gray's Anatomy, still a useful reference book. The word "anatomy" comes from the Greek ana- meaning up or through + tome meaning a cutting. Anatomy was once a "cutting up" because the structure of the body was originally learned through dissecting it, cutting it up. The abbreviation for anatomy is anat.
Ankle: The ankle joint is complex. It is made up of two joints: the true ankle joint and the subtalar joint: See the entire definition of Ankle
Arthritis: Inflammation of a joint. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of arthritis. (see osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout, pseudogout).
Arthroscope: A thin flexible fiberoptic scope which is introduced into a joint space through a small incision in order to carry out diagnostic and treatment procedures within the joint. An arthroscope is about the diameter of a drinking straw. It is fitted with a miniature camera, a light source and precision tools at the end of flexible tubes. An arthroscope can be used not only for diagnostic procedures but a wide range of surgical repairs, such as debridement, or cleaning, of a joint to remove bits of torn cartilage , ligament reconstruction, and synovectomy (removal of the joint lining). All are done without a major, invasive operation, and, since arthroscopy requires only tiny incisions, many procedures can be done on an outpatient basis with local anesthetic. See the entire definition of Arthroscope
Atrophy: Wasting away or diminution. Muscle atrophy is wasting of muscle, decrease in muscle mass.

Blood: The familiar red fluid in the body that contains white and red blood cells, platelets, proteins, and other elements. The blood is transported throughout the body by the circulatory system. Blood functions in two directions: arterial and venous. Arterial blood is the means by which oxygen and nutrients are transported to tissues while venous blood is the means by which carbon dioxide and metabolic by-products are transported to the lungs and kidneys, respectively, for removal from the body.
Blood sugar: Blood glucose. See also: High blood sugar; Low blood sugar.
Bone: Bone is the substance that forms the skeleton of the body. It is composed chiefly of calcium phosphate and calcium carbonate . It also serves as a storage area for calcium, playing a large role in calcium balance in the blood.

Carpal tunnel release: A surgical procedure to relieve pressure exerted on the median nerve within the carpal tunnel (the carpal tunnel syndrome). The median nerve is pinched in the wrist as it passes through the carpal tunnel. The buildup of scar tissue inside the carpal tunnel leads to this problem. Treatment options include splinting, anti-inflammatory agents, and surgery. The surgical release is performed via a small incision using conventional surgery or a fiberoptic scope (endoscopic carpal tunnel repair).
Carpal tunnel syndrome: A type of compression neuropathy (nerve damage) caused by compression and irritation of the median nerve in the wrist. The nerve is compressed within the carpal tunnel, a bony canal in the palm side of the wrist that provides passage for the median nerve to the hand. The irritation of the median nerve is specifically due to pressure from the transverse carpal ligament. See the entire definition of Carpal tunnel syndrome

This is how it feels

How does a patient with carpal tunnel syndrome feel?Patients with carpal tunnel syndrome initially feel numbness and tingling of the hand in the distribution of the median nerve (the thumb, index, middle, and part of the fourth fingers). These sensations are often more pronounced at night and can awaken patients from sleep. The reason symptoms are worse at night may be related to the flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress.

As the disease progresses, patients can develop a burning sensation, cramping and weakness of the hand. Decreased grip strength can lead to frequent dropping of objects from the hand. Occasionally, sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles, particularly those near the base of the thumb in the palm of the hand.

Protecting your wrists at home

At The Factory or Home
Rest your hands frequently, especially when any tingling, numbness, pain, etc. occurs.
If a repetitive job is awkward, try to find a better way to accomplish it.
When using vibrating tools, try to insulate the vibration from your hands with gloves, padding, etc.
Alternate easy and hard tasks that use your hands.
Keep your wrist in a neutral position as much as possible, not bent or twisted.
Use your whole hand to grasp objects, not just your thumb and index finger.
Give your hand and wrist time to recover after forceful movements.
Don't carry heavy objects for long periods. Use jacks, carts, dollies, etc. whenever possible.
Increase the diameter of the handles of tools and equipment with tape, foam or other materials to help reduce the force of your grip and to spread the pressure more evenly over the hand.
Keep your hands warm to promote circulation.
Avoid sleeping on or with your hands bent at the wrist. If you experience CTS symptoms at night due to this, wrist splints may help.
Cut back or discontinue the use of tobacco products.

Ergonomic Tips

At the Office
Rest your hands frequently, especially when any tingling, numbness, pain, cramping, etc. occurs.
Try and control your mouse with the lightest possible grip.
Rest your palms, not your wrist, on a wrist-rest or the desktop.
When using a keyboard/mouse, your hands should be even or slightly lower than your elbows. An adjustable keyboard tray mounted under the desktop may be necessary.
Keep your hands in-line with your forearms as much as possible, not bent in/out or up/down at the wrist.
Rest your elbows on your chair's armrests and adjust them so the weight of your arms is supported by the armrests, not supported by your shoulders.
Use a foot rest if your feet aren't flat on the floor.
The top of your monitor should be about eye level so you aren't bending your neck up or too far down.
Sit upright so your head is above your shoulders. Don't slouch forward.
Take frequent breaks and do stretching exercises to replenish blood flow which is restricted by continuous muscle use, especially involving your hands.
Alter your posture from time to time but keep within the guidelines of correct sitting most of the time.
Sit so the natural hollow stays in your lower back. A good adjustable chair should allow this.
Position your monitor and keyboard in front of you, not to the side.
Use larger barreled pens (1/2"+ diameter) to make them easier to grasp.
Don't wear wrist splints for extended periods during the day. Some muscles may atrophy.
Don't type with long fingernails.
Cut back or discontinue the use of tobacco products.
source-thehelpinghand.com

A useful Glossary Related to CTS

Glossary of Terms

Median Nerve
a major nerve to the hand that controls the thumb, index and middle fingers
Carpal Tunnel
a passage in the wrist through which the median nerve and tendons travel to the hand, much of it located at the base of the palm
Transverse Carpal Ligament
a tough but elastic structure which holds the bones of the Carpal Tunnel together, often surgically cut to relieve pressure on the median nerve
Repetitive Strain Injuries (RSI), Cumulative Trauma Disorder (CTD), Repetitive Motion Syndrome (RMS), Occupational Overuse Syndrome (OOS)
synonymous terms for disorders caused by prolonged, repetitious tasks
Carpal Tunnel Syndrome (CTS)
pressure (or compression) on the median nerve that may cause pain, numbness, weakness, etc.
Tendonitis
inflammation of a tendon, the structures that link muscles to bones
Tenosynovitis
inflammation of a tendon's sheath which causes it to swell and may also retard proper lubrication of the tendon inducing more injury
Carpal Canal
sometimes used interchangeably with Carpal Tunnel
Ulnar Nerve
another main nerve to the hand which controls the last two fingers, it passes outside the carpal tunnel but can be affected by tennis elbow or displacement

In advanced cases of CTS

In very advanced cases, a procedure called a Carpal Tunnel Release Operation is performed. It involves cutting the Transverse Carpal Ligament and letting it heal back together. This gives more room for the soft tissues and therefore lowers the pressure. Surgery is expensive, usually requires many weeks to recover, and is far from being a guaranteed cure. However, there is another approach. Even though the transverse carpal ligament doesn't automatically stretch to accommodate swelling, it can be stretched externally. This technique can be used a preventative method, as well as, a way to help relieve symptoms before they spiral out of control.

What To Do, What To Do....

The most common first aid is to treat the cause of the swelling with drugs. By trying to reduce the swelling, the pressure is decreased and if the median nerve is not damaged, it's function can be restored. However, many times the tissues are so enlarged that drugs can't reduce their size. Another approach is to use braces. Braces keep the hand in a position that prevents the wearer from causing even more damage due to bending or twisting at the wrist with the hopes that the pressure will subside in time. Braces are often used in conjunction with drug therapies. In addition, changing the way you use your hands can be beneficial. See this Ergonomic Tips page for suggestions. Just minor changes such as lowering your keyboard height can significantly raise the threshold of effort needed to make the symptoms arise.

How CTS Happens

The Carpal Tunnel is made up of several bones connected by ligaments. The largest of which is the Transverse Carpal Ligament. These structures form the perimeter of a passage through its center called the carpal tunnel (also called the carpal canal). Through this tunnel run nerves, tendons, blood and other soft tissues. For a variety of reasons some of these soft tissues swell, especially the tendons (red) and the protective sheaths that cover them. Overuse (Repetitive Strain Injury or RSI), injuries such as sprains, friction between the tendons and their protective sheaths, fractures, fluid retention, forceful movements and infection are a few of the more common causes. However, unlike most of your body where swelling simply protrudes, this swelling has no place to expand since it is encircled by bones and ligaments. Consequently, because the swelling is contained, pressure builds in the tunnel. This pressure then crushes the main nerve to your hand called the Median Nerve, causing it not to function properly. The pressure also obstructs blood flow which retards healing and causes further cell degeneration until the cycle spirals out of control. The results are the symptoms listed above and most victims are amazed by the swiftness mild symptoms can progress into a major problem.

Carpal Tunnel

It causes sensory conduction changes in the nerves, so people perceive that their hand is numb. Sometimes, they perceive it as pain," said Dr. Peter Murray, a surgeon at the Mayo Clinic.
Murray says it may also cause weakness.

"If I was using a wrench or something, it would just slip out of my hands," Mendez said.
The treatment you choose will likely depend on the severity of your symptoms. If you've had the condition for less than 12 months, splinting, injections and time may help resolve the problem.

If symptoms have lasted longer than a year, surgery may be necessary.
During carpal tunnel release surgery, doctors make a small incision through which they cut the tight carpal ligament. This releases pressure off the nerve.
Some studies show up to 99 percent of people who have carpal tunnel surgery gain relief from symptoms.

But, Murray has shown in a recent study that results of surgery may not be as good if you're over 75 years of age, or have had carpal tunnel for a long time.
Older people may also have other conditions, such as diabetes or arthritis, that cause overlapping symptoms.
However, Mendez, who's only 58 years old, says surgery has allowed him to return to work in full force.
"
I'm back in action now," he said.
About 250,000 carpal tunnel release operations are performed each year, and almost half of those patients say their conditions are work-related.

Phalen's Maneuver

A common test for CTS is Phalen's Maneuver. Put the backs of your hands together while keeping your arms parallel to the floor and your fingers pointing down. Hold your hands together firmly. If within a minute, you experience one, or a combination, of the symptoms, you probably have the disorder. Don't hold this position for more than a minute or after any symptoms occur.

What happens if I have CTS?

Fatigue, Pain, Tingling, Weakness of Grip, Loss of Dexterity, Stiffness, Cramping, Numbness, Cold, Burning. They may often occur during or after periods of rest or sleep. In advanced cases, you may feel pain or cramping around the base of the thumb or your thumb may become nonfunctional.These symptoms often characterize the common disorder. By the time you feel any of them in your hand, wrist or arm, cell degeneration is in process and should be taken seriously. It often progresses rapidly if ignored and doesn't take years to develop as many think. Often, just a few mild instances suddenly never go away or are brought on by ever decreasing effort.

What happens if I have CTS?

Fatigue, Pain, Tingling, Weakness of Grip, Loss of Dexterity, Stiffness, Cramping, Numbness, Cold, Burning. They may often occur during or after periods of rest or sleep. In advanced cases, you may feel pain or cramping around the base of the thumb or your thumb may become nonfunctional.These symptoms often characterize the common disorder. By the time you feel any of them in your hand, wrist or arm, cell degeneration is in process and should be taken seriously. It often progresses rapidly if ignored and doesn't take years to develop as many think. Often, just a few mild instances suddenly never go away or are brought on by ever decreasing effort.

Where the name come from

Carpus is a word derived from the Greek word "karpos" which means "wrist." The wrist is surrounded by a band of fibrous tissue which normally functions as a support for the joint. The tight space between this fibrous band and the wrist bone is called the carpal tunnel. The median nerve passes through the carpal tunnel to receive sensations from the thumb, index, and middle fingers of the hand. Any condition that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve. Irritation of the median nerve in this manner causes tingling and numbness of the thumb, index, and the middle fingers, a condition known as "carpal tunnel syndrome."

Research being done on CTS

Much of the on-going research on carpal tunnel syndrome is aimed at prevention and rehabilitation. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is funding research on carpal tunnel syndrome.

Medications or Surgery?

Medications:NSAIDS (Nonsteroidal anti-inflammatory drugs) are commonly used to treat CTS. Available over the counter or by prescription, they fight inflammation or swelling and relieve pain. Cortisone injections into the area may lessen the swelling and ease pressure on the nerve.Vitamins:In some studies deficiencies of vitamin B6 have been associated with CTS. One study supported this association and, furthermore, reported that high levels of vitamin B6 were associated with fewer CTS symptoms. Further studies are needed.

Surgery:In more severe cases surgery to widen the carpal tunnel may be needed. Surgery consists of releasing the ligament that forms the tight roof of the carpal tunnel. This opens and widens the carpal tunnel allowing plenty of room for everything in it and relieving pressure on the nerve. There are several methods to do this. The standard surgery has involved a 2-3 inch incision. The newer endoscopic procedure uses a small 3/4 inch incision through which tiny instruments are inserted to perform the needed surgery. Other methods are used less often and with decreased success.

Support and exercise

Opinions vary on the use of splints and support as a CTS treatment. Working and resting splints used to be common in early, conservative treatment. Except for anecdotal reports, no evidence exists that these supports actually help. Some experts believe that wrist supports may actually increase the problem by reducing circulation and restricting movement so that the shoulder muscles tense up.

A supervised hand and wrist strengthening exercise program offered by physical or occupational therapists may be beneficial. One study found that most people with CTS felt improvement after two months of physical therapy that included exercises to improve balance and posture.

This is critical

It is critical to begin treating early phases of CTS before the damage progresses. If possible the person should avoid activities at work or home that may aggravate the condition. Conservative treatment seems to work best in men under 40 and least well in young women.The affected hand and wrist should be rested for at least two weeks; this allows the swollen, inflamed tissues to shrink and relieves pressure on the median nerve. Ice may provide relief.

CTS Diagnosis

There are many conditions that can cause symptoms similar to carpal tunnel syndrome. It is important to be examined by an orthopaedic surgeon or a neurologist, to make sure you do have carpal tunnel syndrome and not something else. A test called a nerve conduction study may be done to evaluate the flow of electricity through the median nerve. Magnetic resonance imaging (MRI) has been found to be accurate in determining the severity of CTS.There are two very simple tests that most doctors do during the initial exam. About two-thirds of individuals with CTS will have an electrical sensation when the doctor taps over the median nerve at the wrist. Another test that is more specific for CTS is reproduction of the symptoms on flexion of the wrist with the forearm held vertically.

CTS symptoms and treatment

Symptoms of carpal tunnel syndrome usually progress gradually over weeks and months and, in some cases, years. The most common symptoms are pain, numbness, and tingling in the wrist, hand, and fingers (except the little finger, which is not affected by the median nerve). There may also be a sense of weakness and a tendency to drop things.

CTS can range from a minor inconvenience to a disabling condition, depending on its cause and persistence. Many cases of CTS are mild, and some resolve on their own. Treatment will be dependent on the severity of each individual case.

What causes CTS?

Anything that causes swelling or irritation of the synovial membranes around the tendons in the carpal tunnel can result in pressure on the median nerve. Some common causes are repetitive and forceful grasping with the hands, repetitive bending of the wrist, broken or dislocated bones in the wrist, obesity, rheumatoid arthritis, thyroid problems, diabetes, hormonal changes of pregnancy and menopause.

What is CTS again?

There is a nerve called the median nerve that travels from the forearm into your hand through a "tunnel" in your wrist. Wrist bones form the bottom and sides of this tunnel; a ligament covers the top of the tunnel. This tunnel also contains nine tendons that connect muscles to bones and bend your fingers and thumb. These tendons are covered with a lubricating membrane called synovium, which may enlarge and swell under some circumstances. This swelling may cause the median nerve to be pressed up against this strong ligament which may result in numbness, tingling in your hand, clumsiness or pain.