Carpal tunnel syndrome (CTS) is a common condition affecting the hands, wrists, arms, and including the neck region of many patients. It is about more commonly diagnosed in women than men, and occurs mostly during middle age (40-60 years).

Carpal tunnel syndrome often strikes those who work in manufacturing, assembly or piecework, or even at computers, and engage in repetitive hand motions throughout the day. CTS often affects those who: 

• Use power tools regularly and experience constant vibration on the hands 
• Work in construction handling heavy objects 
• Use computer or keyboards extensively 
• Play a musical instrument 
• Cycle, resulting in pressure and vibration on hands 
• Craft or sew

CTS may start as a sharp, shooting pain beginning at the wrist and felt through the length of the arm caused by pressure on a key nerve, known as the median nerve, in the wrist area. The median nerve controls motion and sensation in the thumb and a large portion of the hand. Eight bones in the hand (the carpals) form a tunnel that surrounds several tendons along with the median nerve, giving the condition its name. Swelling, injury or pressure within the tunnel impacts the nerve, resulting in pain or discomfort.

If left untreated, or if the reason for the discomfort is not addressed, the injury can get worse over the long term. Therefore, timely intervention and treatment is the key to managing CTS.

The experts at Harborview Medical Center are leaders in their field and have many years of experience in treating CTS.

The causes of CTS may be the result of a combination of several different factors: 

• Injury, including sprain or fracture 
• Having a smaller carpal tunnel than usual, placing stress on the median nerve 
• Obesity 
• Diabetes 
• Arthritis 
• Pregnancy 
• Double-crush syndrome: the nerves of the hands and arms are pressured from more than one source, such as at the spine and at the wrist.

However, some patients may not have any of these conditions but still have CTS.

Anyone who engages in repetitive stressful motions using their hands either for work or as a hobby is at risk of developing CTS. If the underlying cause for CTS are not addressed (such as work-related injuries), or if the condition is left untreated, the injury can get worse over time. Untreated CTS can lead to long-term nerve and muscle injury, weakness, or other disability.

Your doctor may ask you about the history of the pain, its severity, and its location. In addition, your doctor may ask you about your work and hobbies and the types of physical stress that they might involve. After a thorough physical examination of the hands, wrists, shoulders, and neck areas, the doctor may also make use of specific tests to better understand the extent of the CTS: 

• The Tinel Test: tests for CTS through tapping or applying pressure to the median nerve in the wrist and causing tingling or a shock-like sensation. 
• Wrist-flexion (Phalen) test: The wrists are put into a stress posture for up to 1 minute and then evaluated for the presence of tingling or increasing numbness. 
• Compression test: tingling or numbness may result by applying continuous pressure to the median nerve.

In addition, the doctor may recommend X-ray, MRI, or further neurologic tests, such as: 

• Electromyograms (EMGs). A thin electrode is inserted into the muscle to measure electrical activity in your muscle at rest and as you contract the muscle. 
• Nerve conduction studies. Among the most sensitive tests to measure the speed at which electrical impulses travel along your nerves.

Finally, it is important to rule out conditions that may appear to be CTS, but are actually different, such as: 

• Bursitis (swelling of the cushion areas of the joints) 
• Tendonitis (swelling of the tendons) 
• Writer’s cramp

Long term complications from untreated CTS include:

• Decrease in hand function 
• Nerve damage 
• Muscle damage 
• Pain 
• Disability
  

Although surgery is an option for severe cases of CTS, there are many self-help strategies for dealing with more mild. In general, activity modification, including taking regular breaks throughout the day can also help reduce the stress to the injury. For office workers, it is important that they have good posture while working at the desk or computer and the position of the keyboard is comfortable and not above the level of the elbows, to help reduce the stress on the wrists. For those working with tools or machinery, such as lawn mowers that place stress on the wrists through vibrations, it is important to also try and modify the workspace to reduce the risk of further injury (also known as workplace ergonomics). Other strategies may also be helpful:

• Rest: Resting the hands or switching tasks to reduce the risk of repetitive motion. 
• Splinting: Your doctor may recommend the use of an immobilizing splint, which can help keep the affected area from further injury. 
• Cold packs to reduce swelling 
• Exercise: specialized exercises recommended by your doctor or physical therapist can help rebuild or strengthen injured areas. 
• Medication: over-the-counter remedies, such as non-steroidal anti-inflammatory medication, like aspirin, ibuprofen or naproxen.

If pain and swelling are more severe, your doctor may prescribe oral steroids or administer steroids by injection. If surgery is indicated, there are several surgical options, including open carpal tunnel release surgery. Talk with your doctor to see if these options are right for you.

Though the risks associated with self-help techniques are relatively low, they may only be useful for less severe cases of CTS. In severe cases, or if the symptoms continue, your doctor may recommend further treatments, including steroids of carpal tunnel release (CTR).