Wrist pain is the result of damage incurred to the tendons, ligaments and/or eight bones of the joint connecting the hand to the arm. Located on the inside of the wrist is the carpal tunnel, a pathway from the wrist to the palm that protects the median nerve (the primary nerve to the hand) as well as the tendons that enable the hand to move. When stress is placed upon the wrist and undue pressure is exerted upon the median nerve, carpal tunnel syndrome, a painful condition marked by impaired mobility, can develop.
Causes
Pressure on the median nerve causes carpal tunnel syndrome, and stress in the wrist area created by overuse, extended periods of pointing and flexing the arm and hand tendons, and exerting force onto the ligaments and tendons in the area build up exacerbating pressure. Wrist injury that leads to swelling can create enough pressure, particularly for those whose carpal tunnel is naturally smaller than that of others, giving them predisposition to a problem with the nerve. Health issues such as rheumatoid arthritis, hypothyroidism, overactive pituitary function and water retention related to menopause and pregnancy may also factor into development of the condition.
Stress
Stress compression of the median nerve may cause numbness, pain and weakness in the wrist that travels up through the arm and down into the hand. Parts of the hand may feel inappropriately swollen; the discomfort can feel like itching and burning. The ability to grip objects, move the fingers and retain muscle strength may be lost. These physical symptoms can cause mental stress, which occurs commonly when an injury creates debilitation that changes a person's self-perception. It is optimal in such cases that the stress be properly managed. Otherwise it can impair the recovery process, because stress has been seen to negatively impact the immune system and the body's ability to heal.
Treatment
For those who have not suffered symptoms long, have mild symptoms or are under the age of 50, exploring nonsurgical treatment options is recommended. Modifying activity--such as decreasing frequency of wrist bending and creating pressure, adjusting posture, allowing breaks, reducing level of grip when needed, and keeping the hands warm and loose rather than stiff--can improve symptoms. There are physical and occupational therapy exercises and treatment programs for those with chronic symptoms, and braces for the wrist/hand can be purchased over-the-counter to alleviate discomfort via immobilization. Prescriptive corticosteroids and nonprescriptive anti-inflammatory drugs can also help to relieve pain and discomfort.
Surgery
When the pain and discomfort of carpal tunnel syndrome do not abate after 6 months of symptoms, carpal tunnel release surgery is often recommended. Surgery is performed on an outpatient basis using local anesthesia, which reduces risk of complications caused by general anesthesia. To lower pressure on the median nerve, the carpal ligaments surrounding the wrist are cut. In open release surgery, the carpal ligament is severed to increase the tunnel size by way of a 2-inch-long incision in the wrist. Endoscopic surgery uses two smaller incisions and a camera for precision to cut the ligament, the result being a quicker, more comfortable postoperative recovery period.
Prevention
Most cases originate in the workplace from day-to-day activities involved in job performance. As such, employer allowances of ergonomic practices--either providing designated equipment or enabling rotation of job duties, more frequent breaks and periods for employees to stretch or condition at work--have been the prevailing thought in decreasing the occurrence of carpal tunnel syndrome. However, according to the National Institute of Neurological Disorders and Stroke, there is no conclusive evidence culled from research studies to indicate ergonomic modifications do successfully prevent development of the condition.
