Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a very common musculoskeletal disorder that lately has affected a wider group of population.

CTS is defined as an entrapment neuropathy, which means that the Median Nerve is compressed and irritated by the tendons of the hand-flexors muscles wrapped by the transverse carpal ligament. This results in pain and loss of strength and sensation (paresthesia) on the Thumb, Index, Middle fingers and half of the Ring finger.

The epidemiology shows that women develop CTS 5 times more than men and, at the beginning, it seemed to be characteristic of high-joint-stressing jobs as carpenters, butchers, jackhammer and industrial workers (De Mas, 2008), but now it is observed more often in office jobs; for the first case it is responsible a continuous trauma on the biomechanical structures of the wrist, in the second case it is probably the wrong position of the wrist kept for long hours creating tightness in the hand extensor muscles which stresses the tendons passing through the carpal tunnel.

1 - Carpal tunnel structure and section
1 – Carpal tunnel structure and section
  1. The causes are still not clear but we can identify three categories:
    Idiopathic CTS. Arising without apparent reason. It affects mainly women among the 55th-60th year or during pregnancy (McCabe et al., 2007) (Meems et al., 2015).
  2.  Occupational CTS. It occurs in professionals that have a repetitive use of high force/pressure and/or vibrating tools (Aoori and Spence, 2008).
  3. Traumatic CTS. As a post-fracture result (Amirfeyz and Leslie, 2011)

CTS is still one of the most common reasons of impairment from and for the workplace. It used to be characteristic of very physical jobs that involve hand-held vibratory tools and high levels of physical exposure, particularly during assembly work, food processing and packaging (Kozak et al., 2015), although it is observed an increased presence in the office jobs because the lack of correct posture and ergonomics at the desk.

2 - Percentage of the most pain-affected areas cause by wrong posture
2 – Percentage of the most pain-affected areas cause by wrong posture

The severity varies according to the symptomatology. The most common symptoms are:

• Tingling
• Numbness
• Pain
• Dull ache and discomfort in the hand, forearm or upper arm.
• Burning, prickling sensation (paraesthesia) in the hand similar to pins and needles.
• Dry skin, swelling or changes in the skin colour of the hand.
• Becoming less sensitive to touch (hypoaesthesia).
• Weakness and wasting away (atrophy) of the muscles at the base of the thumb.

There are different approaches for the treatment according to the grade of the inflammation and loss of functionality.
Physiotherapy, in the very early stages, can help relieve the pain by working on muscles, ligaments and tendons of the forearm and hand with manual, ultrasound, and laser therapy (Wolny et al., 2016). Using kinesio tape for support during day and splints for the night and suggesting ergonomics solution and exercises and stretches is also of benefit.

3 - Simple stretches and exercises to relieve pain and help functionality
3 – Simple stretches and exercises to relieve pain and help functionality

It is common practice to prescribe anti-inflammatory or corticosteroids injections for the chronic CTS and in 79% of the cases offered relief for the first 12 weeks but only for 31% of the patients the result was maintained (Blazar et al., 2015), probably because the irritating movement cannot be avoided or ergonomics are not followed.

The last solution is surgery, which is known as carpal tunnel release, and consists in a very small cut on the transverse carpal ligament, that can be done through endoscopy, which sets free the Median nerve increasing the nerve conduction velocity and dissolving the symptomatology (Conzen et al., 2016).

There is still much to research about Carpal Tunnel Syndrome, especially in the prevention field. Luckily though there is already a good level of treatment at any stage of the disorder and, since there has been more awareness about the occupational CTS, many corporate companies pay more attention to their employees health and well-being.

Isabella Fraia, MISCP

Bibliography

Meems, M., Truijens, S., Spek, V., Visser, L. and Pop, V. (2015). Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy: a prospective study. BJOG: An International Journal of Obstetrics & Gynaecology, 122(8), pp.1112-1118.

Kozak, A., Schedlbauer, G., Wirth, T., Euler, U., Westermann, C. and Nienhaus, A. (2015). Association between work-related biomechanical risk factors and the occurrence of carpal tunnel syndrome: an overview of systematic reviews and a meta-analysis of current research. BMC Musculoskeletal Disorders, 16(1).

McCabe, S., Uebele, A., Pihur, V., Rosales, R. and Atroshi, I. (2007). Epidemiologic Associations of Carpal Tunnel Syndrome and Sleep Position: Is There a Case for Causation?. HAND, 2(3), pp.127-134.

De Mas, A. (2008). L A SINDROME DEL TUNNEL CARPALE PROFESSIONALE : ASPETTI MEDICO – LEGALI E STUDIO EPIDEMIOLOGICO. Riv Chir Mano, 45(1).

Blazar, P., Floyd, W., Han, C., Rozental, T. and Earp, B. (2015). Prognostic Indicators for Recurrent Symptoms After a Single Corticosteroid Injection for Carpal Tunnel Syndrome. The Journal of Bone & Joint Surgery, 97(19), pp.1563-1570.

Aoori, S. and Spence, R. (2008). Carpal Tunnel Syndrome. The Ulster Medical Journal, 77(1), pp.6-17.

Wolny, T., Saulicz, E., Linek, P., Myśliwiec, A. and Saulicz, M. (2016). Effect of manual therapy and neurodynamic techniques vs ultrasound and laser on 2PD in patients with CTS: A randomized controlled trial. Journal of Hand Therapy.

Amirfeyz, R. and Leslie, I. (2011). AAOS (American Academy of Orthopaedic Surgeons) Clinical Practice Guideline. Treatment of carpal tunnel syndrome. Orthopaedics and Trauma, 25(1), p.78.

Conzen, C., Conzen, M., Rübsamen, N. and Mikolajczyk, R. (2016). Predictors of the patient-centered outcomes of surgical carpal tunnel release – a prospective cohort study. BMC Musculoskeletal Disorders, 17(1).

Images

(1) My-personaltrainer.it. (2016). Sindrome del Tunnel Carpale. [online] Available at: http://www.my-personaltrainer.it/salute-benessere/sindrome-tunnel-carpale.html [Accessed 10 Mar. 2016].

(2) Fast Company. (2013). The Science Of Posture: Why Sitting Up Straight Makes You Happier And More Productive. [online] Available at: http://www.fastcompany.com/3021985/work-smart/the-science-of-posture-why-sitting-up-straight-makes-you-happier-and-more-product [Accessed 30 May 2016].

(3) Ask Ergo Works. (2016). Carpal Tunnel: Remedies & Exercises | Ask ERGO Works – Ask Ergo Works. [online] Available at: http://askergoworks.com/blogs/posts/114117700-carpal-tunnel-syndrome-remedies-exercises [Accessed 30 May 2016].