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The highly skilled, well-trained doctors and surgeons at Cedars-Sinai Marina del Rey Hospital will evaluate patients with carpal tunnel syndrome and propose an individualized treatment plan that is most appropriate for their condition.
Carpal tunnel syndrome (CTS) is a condition that occurs as a result of the compression of the median nerve in the wrist. The median nerve, along with the tendons that keep the wrist joint flexible, are housed in a narrow but rigid canal made up of bones and ligaments called the carpal tunnel. Excessive swelling of the tissue around the tendons can lead to the narrowing of this canal, which puts an abnormal amount of pressure on the median nerve. Factors that contribute to the development of CTS include traumatic injuries to the wrist, thyroid disorders, rheumatoid arthritis, and pregnancy-associated fluid retention in the body. Symptoms of CTS develop gradually and usually include tingling, numbness, pain, and weakness in the wrist, thumb, index, or middle fingers. Some people may experience difficulty grasping small items and performing daily tasks. Early detection and treatment of CTS are very important, as the condition may worsen over time. If left untreated, CTS can cause median nerve damage, along with heightened symptoms. in these cases, surgery may be required.
Surgical treatment is usually recommended when conservative treatment methods fail to alleviate a patient's pain or symptoms. For patients with continuous numbness and muscle weakness lasting for more than six months, surgery is the best option to avoid permanent nerve damage. Carpal tunnel release is the surgical procedure used to treat CTS. Carpal tunnel release involves cutting a ligament in the carpal tunnel and reducing pressure on the median nerve. There are two surgical techniques that can be used to release the carpal tunnel. Most cases of carpal tunnel release are performed as outpatient procedures under general anesthesia, local anesthesia, or intravenous sedation.
Patients with CTS should begin treatment as early as possible after being diagnosed. The first step in treating CTS is treating any underlying diseases, such as arthritis or diabetes, if necessary. The second step requires at least two weeks of rest and immobilization of the hand and wrist in order to avoid further damage. Application of ice packs may help decrease swelling.
The symptoms of CTS develop gradually, with the exception of cases when an injury is involved. Most often, CTS symptoms are initially transient and then become more intense and persistent as the syndrome progresses. Symptoms commonly occur during the night. If symptoms appear during the day, it's usually due to holding an object for an extended period of time with the wrist bent forwards or backwards (i.e. reading a book, driving, holding a phone). CTS symptoms include:
CTS is diagnosed on the basis of a patient's medical history, a careful physical examination of the hand and wrist, and specialized tests, such as nerve conduction studies.
Physical examination: A doctor will perform a complete evaluation of the hand, wrist, and shoulder to determine the causes of nerve compression. They will also check the wrists for signs of swelling, tenderness, and deformities, and evalute the strength of the hand muscles and the sensation in the fingers.
Electrophysiological tests: Electrophysiological tests are performed to check the functions of the median nerve and determine the amount of pressure it is being subjected to. These tests also check for other sites of nerve compression. There are two types of electrophysiological tests:
Various risk factors contribute to the development of CTS. Studies have shown that women are three times more likely to be affected by carpal tunnel syndrome than men. Other risk factors include:
CTS commonly occurs in people with smaller carpal tunnels, which creates an increased amount of pressure on the median nerve and tendons. Other reasons for the development of CTS include traumatic injuries to the wrists, such as sprains or fractures that cause swelling, fluid retention in the body during pregnancy or menopause, hypothyroidism, rheumatoid arthritis, tumors/cysts in the carpal tunnel, pituitary gland overactivity, and repetitive use of vibrating hand-held instruments.
Alternative therapies may be incorporated into your regular treatment plan to alleviate the symptoms of CTS. It is always necessary to consult your doctor before starting any alternative treatment method. A comprehensive treatment plan may be derived from the following alternative treatment options:
Herbal remedies: Herbal remedies, such as extracts of green tea, bromelain, cat’s claw, and turmeric are known to help alleviate symptoms of CTS.
Homeopathic remedies: A person’s physical shape, emotional state, and psychological profile should be taken into account before prescribing any homeopathic remedies. Some of the most common remedies used for CTS include Arnica montana, Guaiacum, and Apis mellifica.
Acupuncture: Studies have shown that acupuncture can restore the functions of nerves and provide relief from pain associated with CTS.
Chiropractic treatment: Chiropactic treatment involves the manipulation of the wrist and elbow joints, upper spine, and wrist support, as well as ultrasound therapy. It has been shown to cause significant improvement in range of movement, pain relief, and muscle strength in people with CTS. Ultrasound therapy involves the use of a high-intensity ultrasound to increase the temperature of a targeted area in the body in order to reduce pain and facilitate healing. Doing several weeks of ultrasound therapy can help relieve symptoms of CTS.
Yoga: Yoga postures that focus on stretching, strengthening, and balancing the joints of the upper body can help alleviate the pain and improve the grip strength associated with CTS.
The first step in preventing CTS is making lifestyle changes that reduce the risk factors associated with the condition. It is also important to properly treat conditions such as diabetes, arthritis, and high blood pressure. Physical therapy exercises can also be helpful in preventing CTS. Here are some useful tips that can be used to prevent carpal tunnel syndrome, and alleviate its symptoms:
Are you enciphering signs of carpal tunnel syndrome? Doctors and surgeons at Cedars-Sinai Marina del Rey Hospital can answer any questions and provide information and guidance related to the treatment of CTS.
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