Focus On: Chronic carpal tunnel syndrome 

It is important to look at all aspects of disease. In the case of carpal tunnel syndrome there is a debate 
brewing as to the nature and cause of this specific problem. 
Carpal tunnel syndrome accounts for 40 % of work place injuries. 

Is it truly related to the work environment?
Causes: Symptoms of carpal tunnel syndrome result from compression on the median nerve as is runs beneath 
the flexor retinaculum in the wrists. 
This compression causes decreased blood flow to the nerve and impaired transmission of the nerve signals.

How does this compression occur? 
New evidence indicates that carpal tunnel syndrome occurs due to both systemic and local factors concurrently. 
In fact, there is less and less evidence to support carpal tunnel as an overuse condition. 

How do you know you have carpal tunnel? 
EMG (electromyogram) and nerve conduction studies are helpful in determining to what extent you carpal 
tunnel has occurred. These studies can be ordered by your physician.
New evidence being brought to the forefront indicates that systemic diseases such as rheumatoid arthritis, 
menopause, hypothyroidism, acromegaly, end-stage renal disease, pregnancy, diabetes, and obesity all can cause the 
symptoms of carpal tunnel syndrome. Smoking and lifetime alcohol intake are also associated with this syndrome as well.

What does this mean regarding your carpal tunnel syndrome? 
It is unlikely that your carpal tunnel syndrome resulted merely from a repetitive strain injury. 
In fact you likely have some underlying disease process occurring which is adding to the syndrome. 
You should be evaluated by your primary care physician for the systemic diseases above.

Treatments: 
Your doctor can prescribe a wrist brace, worn at night and sometimes throughout the day, 
to keep the wrist in a neutral position to minimize nerve compression, anti-inflammatory drugs to minimize swelling, 
exercises and occupational therapy, changes in your office ergonomics, cortisone injections, and finally surgery.

When should I have surgery? 
Surgery should be attempted as a final resort. 
It is not usually recommended unless there is a motor component to your carpal tunnel syndrome. 
Conservative therapy should be attempted first before surgical correction should be performed.

Overall: 
New evidence is pointing more towards chronic carpal tunnel syndrome being related to systemic factors and less 
towards it being related to a repetitive strain injury. All factors should be assessed by your doctor and treatments 
should be according. If the systemic factors are ignored we are missing a big part of the treatment of this common 
syndrome.

Robert Nadratowski MS, PA-C