If tingling/numbness primarily affects your thumb, index, third, and ring fingers, it very well could be carpal tunnel syndrome, or CTS. Chances are you’ve probably had this condition for months or even longer but it’s been more of a nuisance than a “major problem” and therefore, you probably haven’t “bothered” having it checked out. Let’s take a look at some “facts” about CTS!
WHAT IS CTS? CTS is basically a pinched nerve (the median nerve) that occurs on the palm side of the wrist that innervates the three middle fingers and the thumb on the palm side. This nerve starts in the neck, runs through the shoulder to enter the arm, and travels down the palm side forearm through the carpal tunnel. The carpal tunnel is made up by eight small bones (called “carpal bones”) that form the roof and walls of the tunnel. The floor of the tunnel is a ligament called the transverse carpal ligament. The median nerve lies immediately on the floor, and deeper inside the tunnel are nine tendons that connect the muscles of our forearm to the fingers, which allow us to make a fist and grip. When swelling occurs inside the tunnel, the nerve is pinched against the floor (ligament) and symptoms occur.
SYMPTOMS OF CTS: Symptoms typically start gradually with tingling, numbness, burning, itching, or a “half-sleep” feeling in the palm of the hand, thumb, and middle three fingers. The fingers can feel swollen and weak, though “swelling” is usually NOT visible. CTS can occur in one or both hands, but it is usually worse in the dominant hand. Initially, you may only notice symptoms at night or in the morning. As CTS worsens, sleep interruptions, grip weakness, difficulty distinguishing hot from cold, increased pain, pain radiating up the arm, and more may occur.
CAUSES OF CTS: There are many causes of CTS that often occur in combination: 1) Heredity or genetics — being born with a smaller wrist than others; 2) Trauma — a fall on the arm/hand (sprain or fracture); 3) Overuse of the arms/hands (like repetitive line work, serving tables, or using a computer), 4) Hormonal causes — during menstruation, with pregnancy, during menopause, diabetes, hypothyroid, overactive pituitary gland; 5) Rheumatoid arthritis; 6) Fluid retention; 7) Cysts, tumors, or spurs inside the tunnel; 8) Vibrating tools, 9) Hobbies such as knitting, sewing, crocheting; 10) sports; or 11) an “Insidious” or unknown cause!
CTS RISK FACTORS: 1) Gender: Women are three times more likely to develop CTS, possibly because they generally have a smaller carpal tunnel than men, in addition to hormonal differences; 2) Diabetes or other metabolic disorders; 3) Adults, especially >50 years old; 4) Job demands.
CTS DIAGNOSIS: Your doctor of chiropractic will review your patient history and then evaluate the neck, shoulder, arm, and hand, as ALL can be involved in producing CTS-like symptoms. He/she may also order blood tests (to check for diabetes, thyroid levels, rheumatoid arthritis, etc.) and/or an EMG/NCV (electromyogram/nerve conduction studies) to test for nerve damage.
We will FINISH THIS interesting discussion next week covering: Treatment, prevention, and research.