One of the most common problems seen in a rheumatologist\’s office is carpal tunnel syndrome (CTS). Carpal tunnel syndrome is a condition due to pressure on the median nerve, the major nerve that passes from the forearm into the hand.

The median nerve runs through a narrow tunnel formed by the eight carpal bones of the wrist. The roof of the channel is formed by a tough piece of fibrous tissue called the flexor retinaculum.

This problem affects about 9 million people in the United States. While CTS is often due to other medical conditions such as rheumatoid arthritis, hypothyroidism, gout, trauma, and pregnancy, it most commonly develops from repetitive motion.

Those who are most susceptible to developing CTS are mechanics, cashiers, carpenters, grocery store checkers, assembly-line workers, musicians, gardeners and knitters. Heavy computer use and typing also may lead to CTS.

Symptoms of carpal tunnel syndrome include:
– Wrist pain running into the hand or up the forearm… sometimes even into the neck
– Swelling in the wrist and hand
– Numbness, burning and tingling in the hand, particularly at night
– Pain with movement of the wrist or hand
– Weakness in the thumb and first two fingers
– Loss of grip strength
– Muscle atrophy in the meaty part of the palm next to the thumb.

Patients will often say they drape their hands over the side of the bed or they shake their hands to get some feeling back into them. Women are three times more likely than men to suffer from CTS. Hormonal changes occurring during pregnancy and menopause may make women more susceptible.

If a person develops carpal tunnel symptoms, they should see a physician, either a rheumatologist or orthopedist.

The diagnosis is suspected clinically by history and physical examination. It can be confirmed using electrical nerve conduction testing. Also, diagnostic ultrasound can be used to corroborate the diagnosis. Care must be paid since pinching of nerves in the neck can also complicate diagnosis and treatment.

Once the diagnosis is established, then treatment can be carried out.

Treatment options include:
-Non-invasive measures such as physical therapy, yoga, ultrasound, chiropractic manipulation, acupuncture, and massage. T hese non-invasive modalities may help a great deal.

– A cock-up wrist splint worn at night can also help with symptoms.

– Rest from the repetitive motion is a must.

– Non-steroidal anti-inflammatory drugs such as aspirin , ibuprofen and other non-prescription pain relievers can help relieve symptoms. Be wary of potential side-effects.

– Corticosteroid injections may be very helpful. These injections should be done using ultrasound guidance and a splint should be applied for at least a week following the injection.

– A new method of ultrasound guided carpal tunnel release using a needle is gaining more popularity. This method is less invasive than surgical techniques with minimal downtime. While not effective for everyone, it works well for many individuals.

– CTS surgery is reserved for severe cases after other treatments have failed. Most patients can have their surgery done endoscopically.

One other consideration is the workplace. None of the above treatments will be effective if the workplace is not corrected to be \”carpal tunnel friendly.\”

Author Bio: Nathan Wei, MD FACP FACR is a board-certified rheumatologist and nationally known arthritis authority and expert. For more info: Arthritis Treatment and Arthritis Treatment Center

Category: Medicines and Remedies
Keywords: carpal tunnel syndrome, carpal tunnel treatment, ultrasound guided release