July 22, 2002
Neurologist urges early treatment of carpal tunnel syndrome
By Lauren Fairburn
Health and Research News Service
JACKSON, Miss.—A Methodist Rehabilitation Center physician says that early diagnosis and treatment of carpal tunnel syndrome (CTS) can prevent long-term nerve damage and pain.
CTS occurs when ligaments or tendons in the wrist become inflamed and cause the median nerve in the wrist to compress. Wrist bones form the floor of the tunnel and a tight ligament forms its roof. Within the tunnel, muscle tendons and fibrous tissue surround the median nerve.
“Any condition that increases pressure in the tunnel can injure the median nerve and cause carpal tunnel syndrome,” said Dr. Art Leis, a neurologist at Methodist Rehabilitation Center. “The problem will get worse without treatment. That is why early diagnosis and treatment are critical in preventing permanent nerve damage.”
Predisposing conditions for carpal tunnel syndrome include:
- Repetitive strain on the wrist or hand
- Arthritis, especially rheumatoid arthritis
- Thyroid gland problems
Dr. Leis says CTS is by far the most common nerve compression syndrome. It occurs more often in women than men, usually involves the dominant hand and people who use their hands occupationally have a higher incidence of CTS.
“Occupational CTS is widespread and has extensive legal and economic implications. People who work with computers on a daily basis and assembly line workers are at greater risk for developing carpal tunnel syndrome,” said Dr. Leis.
Symptoms of carpal tunnel syndrome include:
- Pain, numbness and tingling in the hands, aggravated by repetitive use
- Patients characteristically awaken at night with symptoms
- Stiffness, clumsiness or weakness of the hand and difficulty gripping or making a fist
- Hand pain may radiate up into the forearm, arm or shoulder
- A swollen feeling in the fingers
- Atrophy of muscles in the palm
Dr. Leis says that when CTS is treated in the early stage, the syndrome can often be reversed with appropriate modification of activities, anti-inflammatory medications and a wrist brace. Treatment in the moderate stage of the disease may involve steroid injections into the carpal tunnel, which reduces inflammation and swelling and relieves pressure on the nerve. In severe CTS, or when conservative treatment has failed and pain persists, surgical intervention is needed.
“Patients with advanced CTS often have weakness and wasting of muscles that control thumb movement,” Dr. Leis said. “In these cases, pressure on the median nerve is relieved by surgically cutting the ligament that forms the roof of the carpal tunnel. This operation is known as a carpal tunnel release and can be performed in an outpatient setting.”
Carpal tunnel syndrome can be diagnosed through a detailed medical history or by conducting one of the following tests:
- A nerve conduction study measures a nerve’s ability to send electrical impulses.
- Quantitative sensory testing records detection thresholds of cold sensation, warm sensation and pain in the hand.
- A tap on the front of the wrist to check for tingling or pain (Tinel’s sign).
- Flex the wrist all the way down and hold for one minute and then release to check for tingling or pain (Phalen’s sign). Extend the wrist all the way up and hold for one minute, then release to check for tingling or pain (reverse Phalen’s sign).
- Blood tests and X-rays are used to check for other medical conditions.