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What Is Carpal Tunnel Syndrome?

The carpal tunnel is a passageway that runs from the forearm through the wrist. Bones form three walls of the tunnel and a strong, broad ligament bridges over them. The median nerve, which supplies feeling to the thumb, index, and ring fingers, and the nine tendons that flex the fingers, passes through this tunnel. This nerve also provides function for themuscles at the base of the thumb (the thenar muscles). Usually, carpal tunnel syndrome (CTS) is considered an inflammatory disorder caused by repetitive stress, physical injury, or other conditions that cause the tissues around the median nerve to become swollen. It occurs either when the protective lining of the tendons within the carpal tunnel become inflamed and swell or when the ligament that formsthe roof becomes thicker and broader. Just as stepping on a hose slows the flow of water through a garden hose, so compression on the median nerve fibers by the swollen tendons and thickened ligament slows down the transmission of nerve signals through the carpal tunnel. The result is pain, numbness, and tingling in the wrist, hand, and fingers (except the little finger, which is not affected bythe median nerve).
Carpal tunnel syndrome is one of a group of disorders categorized by several different terms: repetitive stress injuries, cumulative trauma disorder, overuse syndromes, chronic upper limb pain syndrome, or repetitive motion disorders. All of these problems are generally associated with repetitive and forceful use of the hands that damage muscles and bones of the upperextremities.
What Causes Carpal Tunnel Syndrome?
It is often very difficult to determine whether the primary cause of CTS is primarily due to work conditions or an underlying medical problem. Carpal tunnel syndrome almost always occurs in adults and most adults work; CTS, then, is very likely to be associated with the work place whether or not it is actually caused by the work itself. Indeed, estimatesof work-related CTS vary wildly. Some studies suggest that more than half are due to workplace factors and others that few cases of CTS are actually caused by conditions on the job. In one study, for example, obesity or diseases such as diabetes, hypothyroidism, and arthritis occurred in the majority of people with work-associated CTS. Such conditions are known contributors to carpal tunneldisorder. It is likely that many cases of CTS occur from a combination of factors, including a predisposing medical condition exacerbated by work stress and psychologic and social stressors. In many patients with CTS, an underlying cause for the disorder cannot be discovered.
Work-Related Causes
Disorders related to work that requires repetitive motion are increasing. They account for nearly half ofall reported work-related illness, and carpal tunnel syndrome is estimated to account for over 41% of these repetitive motion disorders. Researchers have defined six key risk factors in the workplace for the development of these disorders, including carpal tunnel syndrome:
1. repetition
2. high force
3. awkward joint posture
4. direct pressure
5. vibration
6. prolonged constrained postureSome experts believe that incorrect posture may play a large role in the development of CTS, particularly in people who work at computer and other types of keyboards. The tendency to roll the shoulders forward, round the lower back, and thrust the chin forward can shorten the neck and shoulder muscles, compressing nerves in the neck. This, in turn, can affect the wrist, fingers, and hand. It has beendifficult, however, to obtain reliable data on the direct link between repetitive hand and wrist tasks and carpal tunnel syndrome.
Studies indicate that psychosocial factors in the workplace, such as intense deadlines, interpersonal relationships, and job design, are major contributors to carpal tunnel pain. Such psychosocial conditions are more likely to be important factors in contributing...