Carpal Tunnel Syndrome:  A Common Household Neuropathy
Most of your patients probably associate neuropathy with extensive nerve damage, like the kind that has to do with diabetes, severe injury, or cancer.  One of the most common forms, though, is a relatively minor condition that affects millions of healthy people, probably including a lot of people you see in your office: carpal tunnel syndrome.
The carpal tunnel is the small space between bones in the wrist that small tendons and the median nerve run through.  The median nerve runs from the forearm into the palm and controls movement and feeling in most of the hand, except for the little finger.   Carpal tunnel syndrome (CTS) occurs when there is pressure on the median nerve in the wrist from swelling or tension.  This is known as mononeuropathy, or neuropathy that affects only a single nerve.

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Patients who suffer from carpal tunnel syndrome usually experience symptoms in their arms and hands that are similar to other kinds of neuropathy.  Soreness, numbness and tingling, loss of temperature sensation and problems with fine motor control are common.  Because the little finger is not controlled with the median nerve, symptoms that affect the other fingers but not the little finger could represent carpal tunnel syndrome.  At first, symptoms usually show up at night (people often sleep with flexed wrists) and go away by shaking the affected hand.  As time passes, though, you might hear that symptoms are sticking around throughout the day.
So who is the most susceptible to getting carpal tunnel syndrome?  Many patients are simply genetically predisposed, usually because they have thinner wrists that constrict the carpal tunnel and the median nerve.  Women are three times more likely than men to develop the condition, again, because of thinner wrists. 
Many people associate carpal tunnel syndrome with heavy computer use.  This is probably unfounded; a 2001 study at the Mayo Clinic found that patients who used a computer for up to 7 hours a day did not show an increased risk of developing CTS.  Carpal Tunnel syndrome is not particularly confined to any specific industry or job over any other, but studies establish that it is more common in workers doing assembly, due to the repetitive nature of the task.  Because of the incorrect “conventional wisdom,” conditions such as tendonitis and writer’s cramp are often mistaken by patients for carpal tunnel syndrome.
As with any neuropathy, it is important to identify carpal tunnel syndrome early to avoid permanent damage to the median nerve.   You should carefully examine a patient’s neck, back, arms, and hands to establish the nature of their symptoms.  Look for discoloration around the wrist and test each finger for sensation.  Check the muscles at the base of the hand and in the fingers for signs of atrophy.  The Tinel test and the Phalen (wrist-flexion) test are the most common methods to detect carpal tunnel syndrome.  Contact NeuropathyDR® if you have any questions about the correct way to perform these inspections. If you suspect an undiagnosed underlying condition might be at the root of the symptoms, consider blood tests to make certain.  Electrodiagnostic tests and ultrasound imaging can also be used to detect damage to the median nerve.
Once a positive diagnosis is made, there are several routes for treatment.  Patients should treat mild conditions at home with ice and rest to reduce swelling. You Might Even Recommend household painkillers such as Tylenol or Aleve to treat pain.  Instruct the patient to avoid activities that might cause repetitive wrist motions for extensive periods without resting.   Patients should keep their wrists in neutral positions as much as possible, such as the way they rest when holding a glass of water.
For more serious cases, or when damage to the nerve has already taken place, more extensive measures may be necessary.  If a patient’s symptoms have continued for more than a few weeks with home treatments, you may want to prescribe our more intensive physical therapy and maybe even short term prescription anti-inflammatory medication.  For the most serious cases of carpal tunnel syndrome, where mobility or nerve function is seriously impaired, surgery can be a solution.  In these rare cases, a surgeon can reduce tension on the median nerve by cutting the ligament that constricts the carpal tunnel. Almost never should this happen though before treating the patient with our unique ND CTS Protocol.
If you have any questions about treating patients with carpal tunnel syndrome or any other kind of neuropathy, don’t hesitate to contact us! NeuropathyDR® is a valuable resource and can help you provide care to the people who count on you.

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