Carpal Tunnel Syndrome
Do Certain Medical Conditions Make People More Likely to Develop Carpal Tunnel Syndrome?
Common medical conditions associated with carpal tunnel syndrome include obesity, pregnancy, hypothyroidism, arthritis, and diabetes. Trauma can also cause carpal tunnel syndrome. In the case of pregnancy, the symptoms usually resolve within a few months after delivery. Women are three times more likely than men to develop the condition, which may be caused by having a smaller carpal tunnel than men in general.
Certain occupations, such as assembly line workers, seamstresses, and hairstylists, may have a higher risk associated with developing carpal tunnel syndrome. Any activity requiring prolonged repetitive use of the arms, wrists, and hands have a significant increased incidence of the developing symptoms.
What Tests Help Diagnose Carpal Tunnel Syndrome?
Two useful clinical tests for diagnosing carpal tunnel syndrome are the Tinel and Phalen maneuvers. Tingling sensations in the fingers caused by tapping on the palm side of the wrist is a positive Tinel test, whereas reproduction of symptoms by flexing the wrist is a positive Phalen test (Dr. Phalen created this maneuver many years ago when he was a hand surgeon at The Cleveland Clinic).
If needed, an electromyogram and nerve conduction studies, are done to document the extent of nerve damage. An electromyogram is a test that measures the electrical activity in your nerves and muscles. Nerve conduction studies measure the ability of specific nerves to transmit electrical impulses or messages.
These tests, however, may not become positive until there is significant nerve damage. In addition, the severity of a person's symptoms is often not correlated with the findings of a nerve conduction study.
How Is Carpal Tunnel Syndrome Treated?
There are several ways to treat carpal tunnel syndrome:
- Lifestyle changes. Treatment first involves adjusting the way the person performs a repetitive motion: Changing the frequency with which the person performs the motion and increasing the amount of rest time between movements.
- Immobilization. Treatment also includes immobilizing the wrist in a splint to minimize or prevent pressure on the nerves. Splints that support the wrist in a comfortable neutral position can be of great value if worn at night to relieve painful numbness or tingling. This can provide a restful sleep and allow the median nerve to endure daytime activities.
- Medication. Patients may be given short courses of anti-inflammatory drugs or injections of steroids in their wrist to reduce swelling. Injections are most successful when people have mild to moderate carpal tunnel syndrome as a result of an acute (severe) flare-up.
- Surgery. If carpal tunnel syndrome does not respond to conservative treatment, then surgery is the next treatment option. During surgery, your surgeon will open the carpal tunnel and cut the ligament, relieving the pressure. Carpal tunnel surgery is quite effective at relieving painful symptoms when the condition involves only nerve constriction.
When carpal tunnel syndrome is just one manifestation of repetitive stress, the surgery cannot be expected to relieve symptoms that are not attributable to carpal tunnel syndrome. The difficulty is not in recovering from the operation, but in recovering the ability to return to work, especially to the same job that caused the repetitive disorder to occur. Whether or not true carpal tunnel symptoms recur in these patients, many continue to have pain and are unable to use their hands to any great extent.