What is Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. The main symptoms are pain, numbness, and tingling in the thumb, index finger, middle finger, and the thumb side of the ring finger. Symptoms typically start gradually and during the night. Pain may extend up the arm. Weak grip strength may occur, and after a long period of time, the muscles at the base of the thumb may waste away. In more than half of the cases, both hands are affected.
Risk factors include obesity, repetitive wrist work, pregnancy, genetics, and rheumatoid arthritis. There is tentative evidence that hypothyroidism increases the risk. Diabetes mellitus is weakly associated with CTS. The use of birth control pills does not affect risk. Types of work that are associated include computer work, work with vibrating tools, and work that requires a strong grip. Diagnosis is suspected based on signs, symptoms, and specific physical tests and may be confirmed with electrodiagnostic tests. If muscle wasting at the base of the thumb is present, the diagnosis is likely.
Being physically active can decrease the risk of developing CTS. Symptoms can be improved by wearing a wrist splint or with corticosteroid injections. Taking NSAIDs or gabapentin does not appear to be useful. Surgery to cut the transverse carpal ligament is effective with better results at a year compared to non-surgical options. Further splinting after surgery is not needed. Evidence does not support magnet therapy.
About 5% of people in the United States have carpal tunnel syndrome. It usually begins in adulthood, and women are more commonly affected than men. Up to 33% of people may improve without specific treatment over approximately a year.
Carpal tunnel syndrome is caused by pressure on the median nerve. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, the symptoms can include numbness, tingling, and weakness in the hand and arm. The anatomy of your wrist, health problems, and possibly repetitive hand motions can contribute to carpal tunnel syndrome. Proper treatment usually relieves the tingling and numbness and restores wrist and hand function.
Symptoms Carpal tunnel syndrome symptoms usually start gradually and include:
Tingling or numbness. You may notice tingling and numbness in your fingers or hand. Usually, the thumb and index, middle, or ring fingers are affected, but not your little finger. You might feel a sensation like an electric shock in these fingers. The sensation may travel from your wrist up to your arm. These symptoms often occur while holding a steering wheel, phone, or newspaper, or may wake you from sleep.
Many people “shake out” their hands to try to relieve their symptoms. The numb feeling may become constant over time. Weakness. You may experience weakness in your hand and drop objects. This may be due to the numbness in your hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.
When to see a doctor:
See your doctor if you have signs and symptoms of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Permanent nerve and muscle damage can occur without treatment.
Carpal tunnel syndrome is caused by pressure on the median nerve. The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).
Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation caused by rheumatoid arthritis. Many times, there is no single cause of carpal tunnel syndrome. It may be that a combination of risk factors contributes to the development of the condition.
A number of factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase the risk of irritation or damage to the median nerve. These include:
- Anatomic factors. A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve. People who have smaller carpal tunnels may be more likely to have carpal tunnel syndrome.
- Sex. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men.
- Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don’t have the condition.
- Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase your risk of nerve damage, including damage to your median nerve.
- Inflammatory conditions. Rheumatoid arthritis and other conditions that have an inflammatory component can affect the lining around the tendons in your wrist and put pressure on your median nerve.
- Medications. Some studies have shown a link between carpal tunnel syndrome and the use of anastrozole (Arimidex), a drug used to treat breast cancer.
- Obesity. Being obese is a risk factor for carpal tunnel syndrome.
- Body fluid changes. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally gets better on its own after pregnancy.
- Other medical conditions. Certain conditions, such as menopause, thyroid disorders, kidney failure, and lymphedema, may increase your chances of carpal tunnel syndrome.
- Workplace factors. Working with vibrating tools or on an assembly line that requires prolonging or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage, especially if the work is done in a cold environment. However, the scientific evidence is conflicting and these factors haven’t been established work as direct causes of carpal tunnel syndrome. Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. Some evidence suggests that it is mouse use and not the use of a keyboard, that may be the problem. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.
There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on your hands and wrists with these methods:
- Reduce your force and relax your grip. If your work involves a cash register or keyboard, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink.
- Take short, frequent breaks. Gently stretch and bend hands and wrists periodically. Alternate tasks when possible. This is especially important if you use equipment that vibrates or that requires you to exert a great amount of force. Even a few minutes each hour can make a difference.
- Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. Keep your keyboard at elbow height or slightly lower.
- Improve your posture. Incorrect posture rolls shoulders forward, shortening your neck and shoulder muscles and compressing nerves in your neck. This can affect your wrists, fingers, and hands, and can cause neck pain.
- Change your computer mouse. Make sure that your computer mouse is comfortable and doesn’t strain your wrist.
- Keep your hands warm. You’re more likely to develop hand pain and stiffness if you work in a cold environment. If you can’t control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.
Your doctor may ask you questions and conduct one or more of the following tests to determine whether you have carpal tunnel syndrome:
- History of symptoms. Your doctor will review the pattern of your symptoms. For example, because the median nerve doesn’t provide sensation to your little finger, symptoms in that finger may indicate a problem other than carpal tunnel syndrome. Carpal tunnel syndrome symptoms usually occur while holding a phone or a newspaper or gripping a steering wheel. They also tend to occur at night and may wake you during the night, or you may notice the numbness when you wake up in the morning.
- Physical examination. Your doctor will conduct a physical examination. He or she will test the feeling in your fingers and the strength of the muscles in your hand. Bending the wrist, tapping on the nerve, or simply pressing on the nerve can trigger symptoms in many people.
- X-ray. Some doctors recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture. However, X-rays are not helpful in making a diagnosis of carpal tunnel syndrome.
- Electromyography. This test measures the tiny electrical discharges produced in muscles. During this test, your doctor inserts a thin needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. This test can identify damage to the muscles controlled by the median nerve, and also may rule out other conditions.
- Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose your condition and rule out other conditions.
Treat carpal tunnel syndrome as early as possible after symptoms start. In the early stages, simple things that you can do for yourself may make the problem go away.
- Take more frequent breaks to rest your hands.
- Avoid activities that make symptoms worse.
- Apply cold packs to reduce swelling.
Other treatment options include wrist splinting, medications, and surgery. Splinting and other conservative treatments are more likely to help if you’ve had only mild to moderate symptoms that come and go for less than 10 months. If you have numbness in your hands, you need to see a doctor.
Surgical and Nonsurgical therapy:
If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome, including:
- Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Even though you only wear the splint at night, it can also help prevent daytime symptoms. Nighttime splinting may be a good option if you’re pregnant because it does not involve the use of any medications to be effective.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.
- There isn’t evidence, however, that these drugs improve carpal tunnel syndrome.
- Corticosteroids. Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve pain. Sometimes your doctor uses an ultrasound to guide these injections. Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren’t considered as effective as corticosteroid injections for treating carpal tunnel syndrome.
If carpal tunnel syndrome is caused by rheumatoid arthritis or other inflammatory arthritis, then treating arthritis may reduce symptoms of carpal tunnel syndrome. However, this is unproven.
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Surgery may be appropriate if your symptoms are severe or don’t respond to other treatments.
The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.
The surgery may be performed with two different techniques:
- Endoscopic surgery. Your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in your hand or wrist. Some surgeons may use ultrasound instead of a telescope to guide the tool that cuts the ligament. Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.
- Open surgery. Your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.
Discuss the risks and benefits of each technique with your surgeon before surgery. Surgery risks may include:
- Incomplete release of the ligament
- Wound infections
- Scar formation
- Injuries to the nerves or blood vessels
During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve. This internal healing process typically takes several months, but the skin heals in a few weeks. Your doctor generally will encourage you to use your hand after the ligament has healed, gradually working back to normal use of your hand while initially avoiding forceful hand motions or extreme wrist positions. Soreness or weakness may take from several weeks to a few months to resolve after surgery. If your symptoms were very severe, symptoms may not go away completely after surgery.
Integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. You may have to experiment to find a treatment that works for you. Always check with your doctor before trying any complementary or alternative treatment.
- Yoga. Yoga postures designed for strengthening, stretching, and balancing the upper body and joints may help reduce pain and improve grip strength.
- Hand therapy. Early research suggests that certain physical and occupational hand therapy techniques may reduce symptoms of carpal tunnel syndrome.
- Ultrasound therapy. High-intensity ultrasound can be used to raise the temperature of a targeted area of body tissue to reduce pain and promote healing. Research shows inconsistent results with this therapy, but a course of ultrasound therapy over several weeks may help reduce symptoms.
Lifestyle and home remedies:
These steps may provide temporary symptom relief:
- Take short, frequent breaks from repetitive activities involving the use of your hands.
- Lose weight if you are overweight or obese.
- Rotate your wrists and stretch your palms and fingers.
- Take a pain reliever, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve).
- Wear a snug, not tight, wrist splint at night. You can find these over-the-counter at most drugstores or pharmacies.
- Avoid sleeping on your hands.
If pain, numbness, or weakness recurs and persists, see your doctor.
I have three sisters and myself that suffer from carpal tunnel syndrome. I believe my sisters got this by doing a lot of typing. I feel I got it from using pneumatic machines. I am an automotive technician, and for thirty years I have been using air tools, the constant vibration and the ways these tools had to be held contributed to my carpal tunnel.
I have one sister who lives in Florida but does make a trip to Canada four times a year for acupuncture treatments. Another one of my sisters underwent surgery but still suffers from pain in her wrists. I personally choose the herbal way.
Acupuncture, an ancient technique of traditional Chinese medicine, has long been used to treat chronic pain, and studies have suggested that it relieves symptoms at least slightly better than a placebo. When coupled with electric stimulation, the technique can work similarly to a more conventional therapy for pain relief called transcutaneous electrical nerve stimulation (TENS).
But exactly how acupuncture works is still largely unknown. Because it’s often difficult to measure pain—and how it changes ‘s—objectively, how well it works also remains uncertain.
How to Get Rid of Carpal Tunnel Syndrome with the Help of Acupuncture:
Carpal tunnel syndrome is one of the most troublesome chronic pain disorders that leads the workers to miss about 31 days per incident on an average while workers suffering from other sorts of injuries tend to lose only nine days per incident on an average. Carpal tunnel syndrome accounts for a massive 900,000 number of cases across the US each year.
The study revealed that acupressure helped in reducing symptoms through “remapping” the patient’s brain. The researchers added that acupuncture also delivered significant healing benefits at the pain source in the wrists of the patient.
The researchers were impressed by the low-risk and minimal-invasive nature of acupuncture to provide substantial relief from carpal tunnel syndrome. Researchers say acupuncture therapy could be useful in treating symptoms and causes of carpal tunnel and other chronic pain ailments.
Acupuncture may be more effective in treating some chronic pain ailments than previously thought. Researchers in a study published today in the journal Brain concluded that acupuncture helped relieve pain for people with carpal tunnel syndrome. The researchers said the acupuncture helped reduce symptoms by “remapping” the brain.
They added the therapy also provided some healing effects at the source of the pain in the patients’ wrists.
Vitaly Napadow, Ph.D., director of the Center for Integrative Pain Neuroimaging, and senior author of the research paper said his group hopes to do more research on acupuncture’s effectiveness on carpal tunnel and other chronic pain ailments.
“One of the benefits of acupuncture is it’s so minimally invasive and has such a low-risk profile,” Napadow told Healthline.
What researchers discovered:
In this study, 80 people with an average age of 49 were tested. The volunteers, 65 of whom were women, were divided into three groups. One group was treated with serum electro-acupuncture at the wrist. Another group was given acupuncture therapy in an ankle on the opposite side of their affected wrist. The third group was given “sham acupuncture” treatments as a control. They were each given 16 treatments over eight weeks. The participants were evaluated after the treatments and then reevaluated three months later.
Napadow said all three groups reported some relief from pain. However, he said the two groups that received acupuncture also showed some physiological changes. High-tech imaging revealed that acupuncture had caused some mapping change’s in the brain. In addition, there appeared to be some healing effects in participants’ wrists.
The group that received treatment in their wrists showed more benefits than the people who got acupuncture in their ankles.
Why acupuncture is effective:
This study was not the first to show that acupuncture can be effective in carpal tunnel syndrome. Researchers conducted studies in 2012 and 2016 and reported that study participants experienced pain relief after receiving acupuncture. However, Napadow said his group’s study also measured the physical change’s acupuncture produced. He said the signals the brain receives after an acupuncture needle is stuck into the skin may in essence “remap” the brain so it modifies pain signals from the wrist.
In addition, he said, the needle punctures at the pain point may cause the body to send extra blood to that spot, much like what happens during bruising. That additional blood may help damaged nerves to heal. “There seem to be some top-down effects,” he noted.
Greater use of acupuncture:
Napadow said acupuncture is an alternative treatment that some people may want to consider before using drugs, or an invasive type of procedure such as surgery, for any kind of chronic pain ailment. He added that acupuncture is already recommended in a number of guidelines for various chronic pain conditions. He said the biggest barrier right now is getting insurance companies to cover these alternative treatments.
For people who might be reluctant to try this ancient Chinese treatment, Napadow said they should consider the validity of the therapy.
Gingko Biloba is one of the oldest folk herbs that helps to provide relief from CST symptoms like numbness by improving blood flow and circulation in the fingers and hands of those with carpal tunnel syndrome.
Gingko Biloba has more than 40 components including flavonoids and terpenoids, these two components are plant-based antioxidants and it’s an effective tonic that aids all conditions including carpal tunnel syndrome and can be consumed in a capsule, tablet form, or as an extract. The concentrated extracts of these ginkgo leaves reduce swelling, and also protects the nerves, and help them heal.
Boswellia is a herb that has powerful properties to ease CST symptoms like pain, joint inflammation, and numbness. It is a natural pain- killer because it possesses boswellic acid which is a chemical substance that exhibits anti-inflammatory properties.
Boswellia blocks the production of prostaglandin and leukotrienes that are a major part of the inflammatory process in the body. The daily intake of this herb is 300 mg twice daily.
Turmeric is a mild herb with anti-inflammatory properties that helps in wrist inflammation. Curcumin, an active ingredient in turmeric suppresses pain through a mechanism similar to drugs.
The recommended dose in cooking is I gm per day and 1500 mg in extract form. You can even stir the powder in water and swallow or make a paste out of it with honey and oatmeal.
Cat’s claw is an effective herbal remedy for treating symptoms associated with carpal tunnel. It has antioxidant, anti-inflammatory properties and many more types of plant chemicals that help to reduce swelling and inflammation of CST. Cat’s claw is prepared from the bark of cat’s claw vine.
The recommended dose is 10-15 mg twice per day. You can even prepare a tea out of it, just take 10 gm of bark leaves and boil it in 8 oz of water for 15 minutes. Let it cool down, strain, and drink it 3 times a day. Pregnant mothers should strictly avoid cat’s claw as it may cause miscarriage.
Ginger is a herb that is best used to reduce swelling and inflammation. It possesses anti-inflammatory properties that help to ease carpal tunnel symptoms. You can either eat raw ginger, as a supplement or ginger tea. Ginger tea can be prepared by adding 10 mg raw ginger in 8 oz of boiling water, strain it, and take it 2-3 times a day.
Apart from following the above remedies, few more steps will give you relief from CST symptoms, this includes rotating your wrist and stretching palms, take breaks from regular activities, eliminate dairy foods from your diet, and include antioxidant foods like fruits and vegetables. Many more herbs will help you with carpal tunnels such as corn silk, castor oil, parsley, wintergreen oil, gravel root, marshmallow root, and skullcap.
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1. Use A Wrist Splint
Using a wrist split can help ease symptoms of carpal tunnel syndrome in a few weeks. A wrist splint works by keeping your wrist straight and relieving pressure on the nerve. It’s best used at night since there’s a greater chance of your hand bending while you’re sleeping. Also, it is important for your joints to move normally during the day in order to prevent it from getting stiff and your muscles from becoming weak. You can use a support bandage during the day to complement this routine.
2. Avoid Activities That Worsen Symptoms
Try to avoid or at least reduce activities that can aggravate the condition. This means any activity that requires you to grip hard or bend your wrist frequently such as using a vibrating tool or playing a musical instrument.
3. Do Hand Exercises
Certain hand exercises can benefit those with carpal tunnel syndrome. Your physical therapist or doctor can help you fine-tune the movements further depending on the intensity of your condition.
The Wrist Flex:
Hold out your arm in front of you with the palm down and gently bend your wrist downward. With your other hand, press the stretched out hand back toward your body. Hold this position for 15 to 30 seconds before straightening your wrist.
The Finger Bend
Hold your fingers out straight. Then bend the middle joints of the fingers down toward your palm. Hold this position for 5 seconds.
The Wrist Stretch
Pick up something light, say a tin of peas, and stretch out your arm with the palm down. Now gently move your wrist upward before bringing it back to the starting position.
The Hand Squeeze
Squeeze a stress ball or rubber ball and hold the position for 5 seconds.
The ancient practice of yoga can also help you tackle carpal tunnel syndrome. One study found that yoga intervention twice a week which aimed at relaxation as well as the balancing, stretching, and strengthening of joints in the upper body significantly improved grip strength and reduced pain. Yoga poses such as dandasana, urdhva hastasana, and garudasana, and the namaste mudra may prove to be especially helpful. Practice initially under an experienced yoga practitioner so you can perfect the moves.
5. Use Ginger For Pain Relief
Here’s an ayurvedic remedy that may help ease pain caused by carpal tunnel syndrome. Slice ginger into flat thin strips and wrap them around your wrist. You can also apply freshly grated ginger. Now cover it with a bandage and leave it for a while.
How does ginger work? According to research, this common herb has anti-inflammatory and pain-relieving properties. In fact, studies even indicate that it’s comparable in efficacy to the commonly used non-steroidal anti-inflammatory drug ibuprofen. And ginger doesn’t just work topically. Drinking a cup of ginger tea can also help fight inflammation from within.
6. Apply A Turmeric Poultice And Drink Up Turmeric Milk
Turmeric is another spice that has traditionally been used in Ayurveda to treat sore joints. You can apply a poultice of turmeric to the affected area, leaving it on for a while. Gulp down a cup of turmeric milk as well to fight symptoms from within.
To prepare turmeric milk, boil half a cup of water with a quarter cup of turmeric powder till it becomes a thick paste. Add a quarter teaspoon of this paste to a cup of milk on low heat and simmer for a couple of minutes. Like ginger, turmeric also has anti-inflammatory and analgesic benefits and has been found to be comparable in effectiveness to ibuprofen.
7. Get Massage Therapy
Massage therapy is also a viable option for pain caused by carpal tunnel syndrome. One study found that when people with this condition undertook weekly massage sessions with a therapist, along with a self-massage routine which could be done daily, their pain and anxiety reduced even as their grip strength improved.
The massage used in the study involved stroking with moderate pressure, focusing on the fingertip to the elbow area. Then a wringing motion was applied to the area, followed again by circular stroking with the thumb and forefinger. Finally, the skin in the area was rolled with the thumb and forefinger. An experienced massage therapist will be able to guide you on the exact massage techniques to be used.
8. Try Chiropractic Treatment
Chiropractic treatment involves the manipulation of your body structure to tackle health issues. One study found that manipulation of the bony joints and soft tissues of the upper body and spine resulted in significant improvement in finger sensation and nerve conduction as well as function and comfort. Zero in on an experienced chiropractor who can suggest a routine based on your individual case.
Thank you for reading.
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