What Exactly is Carpal Tunnel Syndrome

Carpal Tunnel Syndrome – Google the term and you will get over 600,000 hits.  Pick up a magazine or newspaper and there is a chance that you will find some mention of carpal tunnel syndrome.  Wear a brace or cast out in public and everyone will ask if you have carpal tunnel syndrome.  The term has become a commonplace part of our language.  There is even a band that goes by the name of Carpal Tunnel Syndrome. 

However, the term carpal tunnel syndrome has become erroneously associated with all hand pain.  The truth is that many other types of injuries can cause hand pain.  In order to recover completely from repetitive strain pain, it is important to determine the true cause of the pain and not just treat the symptoms.  It is important that we not assume and treat all hand pain as if it were carpal tunnel syndrome.

So, what exactly is carpal tunnel syndrome and how will you know if you have it?

Carpal tunnel syndrome is the compression of the median nerve at the wrist. 

The nerves to the hands are long “threads” that start at the neck, branch under the arm pit, and travel down to the fingers.  The nerves are the power cords that provide the muscles along their pathway with power and provide certain areas of the skin with sensation.  They also assist with circulation and provide the skin with the ability to sweat. 

The carpal bones are the eight small wrist bones that connect the hand to the forearm.  They are arranged, for the most part, in two rows of four bones each.  The arrangement of bones is slightly curved like a “C”.  A strong, thick, wide ligament, the transverse carpal ligament, attaches from one end of the carpal bones to the other.  The bones and the ligament over it create the carpal tunnel.

The median nerve passes through this tunnel on the way to the hand.  Nine tendons also pass through the tunnel along with the nerve.

Tendons are the rope-like end of the muscles that attach muscle to bone.  When the muscle contracts, the rope-like end of the muscle (the tendon) pulls on the bone and creates movement.  The tendons that pass through the carpal tunnel are the eight tendons that bend each of the two finger joints plus the tendon that bends the thumb tip.  These muscles begin at the inside edge of the elbow.

The nerve is the most vulnerable structure in the carpal tunnel.  If there is any swelling of the tendons related to over-use, repetition, poor wrist positioning or any other cause, the nerve gets pinched and the nerve impulses do not travel along the nerve pathway properly.  This can affect muscle power, sensation, and circulation.

The median nerve is responsible for sensation to the thumb, index, middle, and part of the ring finger.  The median nerve is also responsible for the strength to the thick wad of muscles at the base of the thumb.

So the symptoms of a true carpal tunnel syndrome will be numbness or tingling in the thumb, index, middle and ring finger as well as loss of thumb strength and coordination.  The fingers may be painful, the muscles at the base of the thumb may hurt, and sometimes people feel as if they have a tight band around their wrist.  Pain may travel along the forearm muscles towards the elbow and the forearm muscles may become taut.  People say that they often feel as if they are clumsy and they may report that they drop items frequently. They may also feel as if their fingers are slightly swollen.  In advanced cases, the muscles at the base of the thumb may become wasted and flatten.  Pain may radiate all the way up the arm into the shoulder and neck. 

If you have these symptoms, a visit with a physician can help determine if carpal tunnel syndrome is truly the cause.  Sometimes, if the same nerve is pinched higher along in the pathway, other causes can mimic carpal tunnel.  Certain tests, along with your description of the symptoms, can help the doctor make a definitive diagnosis.

Check out these articles for additional information and for tips on preventing carpal tunnel syndrome.

Carpal Tunnel Syndrome - Back to the Basics

Carpal Tunnel Syndrome ABCs
Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

Emergency Preparedness

The other night at sunset we stood in the local park and watched the flames of the Santa Barbara Gap Wildland Fire make their way down the slope of a nearby canyon. It was a truly awesome sight to see these tremendous bursts of flames as the sundowner winds fueled them on. And as we spent the night until the wee hours of the morning listening to the continuous news coverage announcing evacuations, I realized how ill-equipped the majority of us are for emergency situations. This theme of unpreparedness repeated itself as the news announcer took calls from listeners who were reporting their locations and situations. Many were frantically collecting their important papers and valuables or video-taping their home interiors to document for insurance purposes. Several had been given 30 minutes to collect items of importance and leave their homes. One woman reported “running around in circles” trying to get organized and get out in such a short amount of time. To complicate matters, many of us were experiencing wide-spread power outages caused by the ash and smoke short-circuiting the transformers. Although this is not an ergonomic issue, it can be a health and safety issue, which is related. And in lieu of all of the recent events attributed to global warming, I am going to deviate from our normal ergonomic channel and provide tips and information for preparing for a local emergency.
Have a plan. Know what to do and how to care for yourself and your family in the event that fire, police and emergency medical services may be delayed in responding.
• Choose a location to reunite the family if you are separated
• Choose a person outside of the immediate area who will act as the contact for all family members
• Locate shutoff valves for water, gas and electricity and know how to shut them off before an emergency.
• Make copies of vital records and keep them in a safe deposit box. Store the originals safely and have them gathered together in an accessible location in case of the need for a quick exit.
• Keep exits accessible and clear.
• Know the locations of the nearest police and fire departments.
• Take photos or videos of your valuables and keep a copy with a friend or relative in another city or state.
Keep a disaster kit ready at all times. Place the following items in easy to carry containers. This is a partial summary of the most important items.
• Food and water for at least three days
• Water and a water purification kit
• Non-perishable food – make sure you have a can opener as well
• First aid kit and manual
• Blankets or sleeping bags
• A portable radio, flashlights and spare batteries
• Essential medications
• Extra pair of eyeglasses
• Change of clothes
• Extra pair of house and car keys
• A fire extinguisher
• Food, water and restraint (carrier or leash) for pets
• Cash and change
• Large trash bags, tarps and rain ponchos
• Toilet paper
• Sturdy shoes and gloves
• Candles and matches and/or light sticks
• Knife or razor blades
• Tool kit including a wrench for turning off the gas, a screwdriver, pliers and hammer
• Rope
• Food preparation and consumption items (paper towels, plastic utensils, paper plates/cups)
If you have children:
• Make sure that contact and emergency medical information is current and correct.
• Be aware of the emergency plans of your school or day care center.
• Make plans for someone to pick up your children if you are unable to get to them.
• Have extra supplies for children including diapers, wipes, formula, pacifier, canned food and juices.
If you are elderly or have special medical needs:
• Have a current list of medications, allergies, special equipment needs, medical information and contacts including your doctor, pharmacist and family members.
• Have extra batteries in your emergency kit for hearing aids or other special needs equipment.
• Install a security light in each room.
• Keep pathways clear of clutter.
• Have walking aids near you at all times.
• Have a whistle near you to signal for help.
• Have a system in place to have two people you trust check in on you after an emergency. Give them a spare key and show them where your emergency supplies are including special equipment needs.
A special thank you to all of the firefighters and support personnel who are doing such a tremendous job keeping our city safe.
Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.