More than 2.8 million nonfatal workplace injuries were reported in 2012, according to estimates from the Survey of Occupational Injuries and Illnesses conducted by the U.S. Bureau of Labor Statistics. Hours lost for recuperation time from nonfatal injuries do nothing to help the worker or the employer. So, preventing injury and helping the worker return to the workplace are worthwhile goals. Repetitive stress injuries account for 60% of these job-related injures.
Carpal tunnel syndrome (
CTS) also known as median nerve compression is the most common form of repetitive stress injury. CTS can affect clerical workers, computer programmers, data entry workers, sewers, electronics manufacturing line workers, cow milkers (!), gardeners performing hand weeding, musicians, supermarket checkout clerks and locksmiths. Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men.
You may be asking how seemingly benign activities such as typing and clicking a mouse button or work in trades with repetitive fine motion of tools (e.g., screwdrivers) or use of vibrating hand tools could possibly be harmful. The three primary risk factors are poor posture, poor technique, and overuse.
CTS injury occurs when the median nerve that runs from the forearm to the hand becomes compressed inside a narrow tunnel formed by bone and ligament at the wrist. This tunnel contains nerves that conduct sensory and motor impulses to and from the hand. Prolonged repetitive, forceful, or awkward hand movements repeated many times over hours and days, months and years, eventually strain the muscles and tendons of the forearms, wrists, and fingers, causing microscopic tears and inflammation. The injured muscles tend to contract, decreasing range of motion necessary for unimpeded movement. The sheaths that cover essential tendons run out of lubrication because they aren’t given enough time to rest and recuperate, resulting in chafing and pain. Due to this abrasion, tendons become inflamed and can pinch neighboring nerves. This cycle repeats itself over and over, and a long-term, chronic problem results.
Common symptoms of CTS include numbness and tingling in the hand, burning, weakness, decreased grip strength, inability to grasp small objects and even itching in the palm.Left untreated, the pain can move into the elbow, shoulder and neck.
The diagnosis of CTS begins with the doctor’s physical exam with a focus on your neck, arms, wrists, and hands. The exam is to help find out whether your symptoms are caused by compression of the median nerve as it passes through the carpal tunnel in the wrist.
Diagnosis of CTS is confirmed by performing certain tests to detect damage to the median nerve. A positive Tinel’s test or Phalen’s test will indicate damage to the median nerve. Electrodiagnostic testing (EMG/NCV) measures how fast and how well the median nerve transmits messages to muscles and can indicate if there is nerve damage. X-rays, MRI, or ultrasound may also be ordered.
Once the diagnosis of median nerve compression has been confirmed, there are many nonsurgical treatment options. Our team at CHG specializes in the treatment of CTS with physical therapy modalities of electrical stimulation, therapeutic ultrasound, myofascial release, strength and conditioning exercises, ice and paraffin treatment. Kinesio taping is very beneficial and once applied in the office can be worn for days with significant relief. Specific exercises supervised by a physical therapist are also part of our program. Wrist splints can be worn to alleviate pain. You might be recommended to wear the splint after work and particularly during sleeping hours. Pain medication may be prescribed. Studies have shown nonsteroidal anti-inflammatory drugs (NSAIDs) to be ineffective for CTS.
Surgery may be necessary if the symptoms are severe and if the other measures do not provide relief. Surgery should not be the first choice for treatment. Even after surgery, a number of patients may still have some weakness of grip. Surgery is a last resort, but carpal tunnel surgery is among the most common surgical procedures in the U.S.
Have we answered your questions about CTS? Do you have any other questions for us? If you do, please fill out the contact form and we will be happy to respond to you individually.
Yours in Good Health!
