BACKGROUND: Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers, as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel -- a narrow passageway of ligament and bones at the base of the hand -- houses the median nerve and tendon. Thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to compress. The result may be pain, weakness or numbness in the hand and wrist that radiates up the arm.

According to the American Physical Therapy Association, about 5 million Americans have carpal tunnel syndrome. Symptoms include burning, tingling or numbness in the palm of the hand and fingers. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks.

WHAT CAUSES IT? Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve, rather than a problem with the nerve itself. In most cases, patients have a congenital predisposition, such as a smaller carpal tunnel, that makes them susceptible to carpal tunnel syndrome. Some factors that contribute to carpal tunnel syndrome include trauma or injury to the wrist that causes swelling; overactivity of the pituitary gland; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. According to the National Institute of Neurological Disorders and Stroke, there is little data to prove whether repetitive and forceful movements of the hand actually cause carpal tunnel syndrome.

TREATMENT OPTIONS: Carpal tunnel release is one of the most common surgical procedures performed in the United States. Although surgery is highly successful, there are other options for patients with carpal tunnel syndrome. These may include:

Drugs -- Nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen may ease symptoms that have been present for a short time or have been caused by strenuous activity. Corticosteroids such as prednisone or lidocaine can relieve pressure on the median nerve and provide immediate, temporary relief. These drugs can be taken orally or can be injected directly into the wrist.

Braces and cortisone injections -- Many doctors advise patients to sleep in a nighttime brace, which keeps the wrist in line. The brace, along with cortisone injections, lead to significant improvement in many patients. In fact, Dr. Mark Cohen, from RUSH University Medical Center in Chicago, said this combination works for about one-third of patients.

Alternative therapies -- Alternative approaches such as laser acupuncture and yoga have shown some effectiveness for carpal tunnel syndrome patients. Studies show yoga can reduce pain and improve grip strength.

Cold laser -- Another technology, called the cold laser, is a painless way to relieve pain caused by carpal tunnel syndrome. The laser is FDA-approved, and it helps tissue heal by repairing damaged cells.

For More Information, Contact: National Institute of Neurological Disorders and Stroke
www.ninds.nih.gov
Search: "carpal tunnel"

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