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Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the hand, becomes squeezed at the wrist. The median nerve controls the muscles in the hand and also controls the sensation on the palm side of the thumb, index, middle, and part of the ring finger. The carpal tunnel is a small 'tunnel' created by a circular configuration of the wrist bones and a ligament. Tendons, nerves, veins, and arteries pass through this small tunnel but the median nerve is the most superficial structure in this tunnel. When the hand is overworked (such as from long periods of typing, mouse use, or knitting), the tendons are irritated and swell. This increases the pressure in the carpal tunnel and compresses the median nerve against walls of the tunnel.

The early symptoms of a lightly compressed median nerve are only sensory - tingling, pins and needles, numbness, and/or mild decrease in sensation in the fingers. Late stage median nerve compression results in exaggerated sensory symptoms along with decreased strength and atrophy of median nerve innervated muscles in the hand.

For many people, the pressure in the carpal tunnel may be adjusted and symptoms relieved by the following methods; as with any medical issue, consult your doctor to determine which approach is best for you:

  • Work Positioning - If the wrist is strained from poor wrist positioning while typing or using the mouse, consider using an ergonomic keyboard and wrist pads to maintain the wrist in a position; you may also want to try wrist splints, which position the wrist in proper alignment.
  • Sleeping Position - Many people sleep with their both wrists curled forward under their chin. Often people wake up in the middle of the night from pain or in both hands. Try simply 'shaking it out.' If more severe, use a splint to position the wrist so the carpal tunnel will not be compressed during sleep.
  • Exercise - Some people develop CTS because of overuse of the wrist and hands. When the carpal tunnel symptoms have abated, exercise and stretching can condition your forearm muscles allowing you to work harder without as much strain and swelling. A Certified Hand Therapist (CHT) or Occupational or Physical Therapist can develop a customized exercise regiment.
  • Drugs - In some cases, your doctor may be able to prescribe medicines to decrease swelling from irritated tendons or water retention in the extremities.
  • Surgery - If you experience CTS symptoms for over six months with severe sensory symptoms

    that will not 'shake off' and/or demonstrating decrease hand strength, dexterity and visible atrophy of median nerve innervated muscles in the hand, consult a Board Certified Hand Surgeon or Orthopedic Surgeon to determine whether surgery is appropriate.

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