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JointWorks
Hand & Wrist FAQ
What are the causes of carpal tunnel syndrome?
Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve within the carpal tunnel. This disorder is more common in women, possibly due to their smaller carpal tunnel as well as hormonal influences.
Other contributing factors include:
- Trauma or injury to the wrist that cause swelling, such as a sprain or fracture
- Hypothyroidism
- Rheumatoid arthritis
- Wrist arthritis or other mechanical wrist problems
- Work-related repetitive use
- Repeated use of vibrating hand tools
- Fluid retention during pregnancy or menopause
- Development of a cyst or tumor in the carpal tunnel
In many cases, no specific cause can be identified.
How is carpal tunnel syndrome diagnosed?
Early diagnosis and treatment are important to avoid permanent median nerve damage. A thorough physical examination of the hands, arms, shoulders and neck can help determine if the patient's complaints are related to carpal tunnel syndrome or to other pathology in the upper extremity or neck that may mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation and the muscles at the base of the thumb should be examined for signs of atrophy. Routine laboratory tests and x-rays can reveal diabetes, hypothyroidism, arthritis and fractures. Physicians can also use specific tests, such as the Tinel's or Phalen's tests, to try to reproduce the carpal tunnel symptoms. It may be necessary to confirm the diagnosis with electrodiagnostic tests, which can also help determine the severity of median nerve damage.
Who is at risk of developing carpal tunnel syndrome?
The risk of developing carpal tunnel syndrome is not confined to people within a single industry or job. Greater age, female gender, relative overweight, cigarette smoking, and vibrations associated with job tasks significantly increase the risk of developing carpal tunnel syndrome. Pregnancy, diabetes, hypothyroidism, and rheumatoid arthritis are predisposing factors for carpal tunnel syndrome. Women are three times more likely than men to develop carpal tunnel syndrome for reasons mentioned above.
How is carpal tunnel syndrome treated?
Treatment for carpal tunnel syndrome should begin as soon as possible under a physician's supervision. If underlying medical conditions such as diabetes and rheumatoid arthritis are playing a role, they should be addressed by the patient's primary care physician. Early treatment involves avoiding activities that may worsen symptoms as well as night splinting and anti-inflammatory medication. A cortisone injection into the carpal tunnel may provide several months of relief. Ultimately, if symptoms persist in spite of these non-operative measures, surgery is successful in greater than 90% of patients.
How can carpal tunnel syndrome be prevented?
At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, use correct posture and wrist position, and wear wrist splints in the early stages of the disease. Another preventable measure for employers is to develop programs that allow ergonomic assessment and adjustment of the workstation to avoid unnatural postures and over-repetitive exertion. However, research has not conclusively shown that these workplace changes prevent the development of carpal tunnel syndrome.
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