10039903_MCM_OCT2021

The Carpal Tunnel

women are three times more likely to develop CTS than men. The main symptom of CTS is numbness and/or tingling in the fingers, which later becomes pain. Sufferers often claim that their digits feel swollen even though no physical swelling is evident. Symp toms often first appear at night and can cause the afflicted to wake from sleep. During the day, symp toms can take the form of grip weakness, trouble handling small objects, or increased difficulty writing or typing. As the syndrome worsens, there can be difficulty holding onto objects and perform ing simple tasks such as buttoning a shirt or turning a steering wheel. Treatment After diagnosis, there are a few options for treatment of CTS, depending on its severity. In hopes of relieving the issues causing undue pressure upon the median nerve, non-surgical options are typically tried first. They are: • Splinting – wearing a wrist splint at night or during the day helps keep the wrist straight and the carpal tunnel open. The goal is to reduce pressure on the median nerve by giving it as much room as possible, especially during sleep. • Changing Daily Routine – Iden tifying and altering daily tasks that can worsen CTS symptoms can help relieve pain and pres sure in the long run. Something as simple as taking a break from the task, when possible, can go a long way toward recovery. • Over-the-Counter & Prescription Drugs – In certain circumstances, common anti-inflammatories

such as aspirin or ibuprofen may provide short-term relief of the symptoms but, as the condition worsens, they are not enough and stronger corti costeroids such as prednisone are prescribed. For persons experiencing mild symptoms, lidocaine is injected directly into the wrist to relieve pres sure on the median nerve. • Yoga – Improving flexibility and muscle fitness has been shown to relieve pain and in crease grip strength. Yoga, in particular, has shown positive results in people suffering from mild CTS. If the condition continues to worsen, surgery may be a person’s only relief. CTS surgery is the second most common surgery in the U.S. with over 230,000 procedures performed annually. Generally, surgery involves severing the carpal liga ment around the wrist to relieve pressure on the median nerve. There are two types of CTS surgery: • Open Release – A two-inch incision is made in the wrist to sever the carpal ligament and enlarge the carpal tunnel. • Endoscopic – The surgeon makes one or two incisions about a half-inch each, inserts a camera attached to a tube to observe the carpal tunnel via monitor, and then severs the carpal ligament with a small instrument inserted through the tube. This proce dure offers faster recovery and lesspost-operational discom fort, but has a higher risk of complications and possible need for further surgery. t

Surrounded by tendons, ligaments and bones, this narrow passageway leads from the wrist to the hand. The carpal bones make up the bottom and sides of the tunnel, while the carpal ligament covers the top (palm-side). The tunnel allows passage of the me dian nerve and nine tendons that travel from muscles in the forearm to bones in the hand allowing us to move our fingers and thumbs. The median nerve provides feeling to the palm side of the thumb and index, middle and part of the ring fingers (not the little finger). CTS begins when the me dian nerve becomes pressed or squeezed at the wrist due to thick ening from the lining of irritated tendons or other swelling, which causes frequent numbness or tin gling in the fingers and thumbs. Grasping objects or performing manual tasks is difficult and, if left untreated, the muscles at the base of the thumb will waste away, further inhibiting dexterity and strength. People with severe CTS often cannot determine between hot and cold by touch and can suffer burns without feeling it. Cause and Symptoms No single, underlying cause for CTS is known; rather, a com bination of factors is usually the culprit. Wrist trauma or injury, an overactive pituitary gland, an underactive thyroid, rheumatoid arthritis, diabetes, or a cyst or tumor located in the tunnel can play a role in CTS development. The most common cause remains the repeated use of vibrating hand tools, assembly line work and often, repetitive movements. Gender also plays a large role as

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