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Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the tissues surrounding the flexor tendons in the wrist swell and put pressure on the median nerve. These tissues are called the synovium. The synovium lubricates the tendons and makes it easier to move the fingers.
This swelling of the synovium narrows the confined space of the carpal tunnel, and over time, crowds the nerve.
Carpal tunnel syndrome is a common source of hand numbness and pain. It is more common in women than men. CTS can be due to trauma from repetitive work, such as that of retail checkers and cashiers, assembly line workers, meat packers, typists, writers, and accountants. Other factors that can cause CTS include obesity, pregnancy, hypothyroidism, arthritis, and diabetes.

Many things contribute to the development of carpal tunnel syndrome:

  • Heredity
  • Hand use over time can play a role.
  • Hormonal changes related to pregnancy can play a role.
  • Age — the disease occurs more frequently in older people.
  • Medical conditions, including diabetes, rheumatoid arthritis, and thyroid gland imbalance can play a role.

In most cases of carpal tunnel syndrome, there is no single cause.

For most people, carpal tunnel syndrome will progressively worsen without some form of treatment. It may, however, be modified or stopped in the early stages. For example, if symptoms are clearly related to an activity or occupation, the condition may not progress if the occupation or activity is stopped or modified.

Nonsurgical Treatment

If diagnosed and treated early, carpal tunnel syndrome can be relieved without surgery. In cases where the diagnosis is uncertain or the condition is mild to moderate, your doctor will always try simple treatment measures first.

Bracing or splinting. A brace or splint worn at night keeps the wrist in a neutral position. This prevents the nightly irritation to the median nerve that occurs when wrists are curled during sleep. Splints can also be worn during activities that aggravate symptoms.

Medications. Simple medications can help relieve pain. These medications include anti-inflammatory drugs (NSAIDs), such as ibuprofen.

Activity changes. Changing patterns of hand use to avoid positions and activities that aggravate the symptoms may be helpful. If work requirements cause symptoms, changing or modifying jobs may slow or stop progression of the disease.
Steroid injections. A corticosteroid injection will often provide relief, but symptoms may come back.

If detected early, CTS is reversible. Surgery is used only when other treatments have failed. In advanced CTS, particularly if there is profound weakness and muscle atrophy, surgery is done to avoid permanent nerve damage