Treating Carpal Tunnel Syndrome

Do you perform certain motions over and over at work or at play? Do you experience numbness in your palms or fingers? Do you have diabetes, hypothyroidism or rheumatoid arthritis? If so, you could be at risk of developing carpal tunnel syndrome.

Tunnel syndrome — which can occur in parts of the body other than the wrist — is due to a narrowing of the space within the “tunnel” that houses nerves and ligaments. The median nerve, which is located in the tunnel within the carpal, Greek for wrist, provides sensation to the palm, thumb, index, middle finger and part of the ring finger, but oddly enough, not to the pinky. It is protected by eight carpal bones and a band of ligaments. However, when pressure increases on the tunnel, the sensory nerve fibers within the median nerve, which are quite sensitive to ischemia (deprivation of blood supply), can cause tingling and numbness in the hand. In more severe cases, when the motor nerve fibers — also within the median nerve — are compressed, the patient may develop weakness of the hand and lose the ability to flex their thumb or make a full fist.

Repetitive motion seems to be an important culprit in the development of carpal tunnel syndrome (CTS) because the act of extending and flexing the wrist increases pressure on the carpal tunnel. Activities involving repetitive wrist motion can include frequent knitting, typing, bowling or the use of hand-held vibrating tool.

Pregnancy, menopause, hormone replacement therapy, and birth control pills are known to increase swelling or edema, which can put pressure on the body’s tunnels. Further underlying conditions such as rheumatoid arthritis, diabetes, hypothyroidism, smoking, obesity, and vitamin B6 or B12 deficiency also can have a similar affect to carpal tunnel. Also, genetics plays a role, as the tunnels in our body are as individual as we are; some are big and some are naturally small.

Treating CTS depends on the severity, duration and underlying condition. If the patient has hypothyroidism, diabetes or rheumatoid arthritis, these conditions should be controlled first. In addition, weight reduction, smoking cessation, stopping birth control pills or hormone replacements may reverse the effects of CTS. However, if the CTS has progressed, cortisone injections into the carpal tunnel, anti-inflammatory drugs, wearing a wrist splint, physical therapy, breaks in repetitive motions with stretching exercises, and an ergonomically sound work station will probably suffice as treatment. Lastly, if six to eight months of the above conservative treatment does not alleviate symptoms and restore daily function, surgery to free the median nerve would be the next option.

Fortunately, with an early diagnosis and proper treatment, CTS can be reversed and function can be restored, so take an active role in managing your risk factors and use your wrists properly.

Dr. Yong H. Tsai is board-certified in rheumatology, allergy and clinical immunology and has been practicing in this area since 1993. Send questions to Dr. Tsai in care of You also can check his website:

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