How Long Does it Take Somebody to Develop Carpal Tunnel?

The onset of CTS can range from a few days to years depending on the severity of the repetitive activity. Many professionals who are involved in repetitive work will develop CTS at different rates depending on the nature of their work. The Center for Disease Control and Prevention (CDC) reports that the highest rates of CTS were among telephone operators, food and coffee shop attendants, and electromechanical assemblers. A 2007 – 2014 study by California Department of Public Health (CDPH) to identify high-risk industries and occupations for CTS reported that the rate of CTS was among women, and is 3.3 times higher than in men.

The rate was highest among individuals aged 45 – 54 years. The CDPH report identified occupations with higher than average rate (6.7 per 10,000) for CTS among textile workers (44.9), apparel manufacturing workers (43.1), and animal slaughtering and processing workers (39.8). These workers usually are involved in repetitive activities in unsafe and awkward positions. Bureau of Labor Statistics and Occupational Safety and Health Administration (OSHA.) reports that are approximately 900,000 cases involving CTS and that on average, carpal tunnel causes about 31 days of missed work. [1][2][4]

What is Carpal Tunnel

Carpal Tunnel also called Carpal Tunnel Syndrome (CTS) or Carpal Tunnel Disease (CTD) is a (mononeuropathy) nerve entrapment disorder that affects the muscles of the wrist and palm. CTS is caused by a repetitive stress injury which leads to compression of the median nerve. Compression of the median nerve can occur from swelling of the tendon and ligament of the carpal tunnel or from other causes of irritation (e.g. arthritis, diabetes) of the median nerve. Other risk factors include pregnancy, obesity, rheumatoid arthritis, etc. The median nerve originates from the axilla, runs down the length of the forearm, and enters the wrist through the carpal tunnel. It divides into two branches: the recurrent branch and the palmar digital branch. The recurrent branch innervates the thenar muscles, while the palmar digital branch innervates the palmar surface of the hand and part of the fingertips [3]. Symptoms of CTS include numbness, tingling sensation, pain in the wrist, weak grip, atrophied palmar muscles, etc.

Diagnose Carpal Tunnel

It is very important to diagnose and treat CTS very early. A detailed medical history and physical examination of the arms, wrists, and fingers will aid the diagnosis of CTS. Available diagnostics tests such as Tinel’s test and Phalen’s maneuver can aid the determination of CTS. In the Tinel test, the doctor taps on the median nerve to elicit the tingling sensation due to CTS. In Phalen’s maneuver, a positive CTS will cause tingling or numbness when the back of the hands and fingers were pressed together and flexed as far as possible. Electrodiagnostic tests such as electromyography (EMG) can be used to evaluate the electrical recordings of the palm and wrist muscles. MRI, X-ray scans, and ultrasound images of the wrist can also be used for added diagnosis.

Treatment Options for Carpal Tunnel

After a successful diagnosis of Carpal Tunnel Syndrome (CTS), treatment options can include non-surgical and surgical procedures. Non-surgical treatment options are orthotic splints or braces, reduce repetitive hand/wrist activities, use of non-prescription painkillers (NSAIDs) like Ibuprofen (for pain management), and prescription medicines like corticosteroids can be injected directly into the wrist to relieve pain. Alternative non-surgical therapies like yoga, acupuncture, massage, etc. have been reported to alleviate CTS symptoms. CDC reports indicate that 36% of total carpal tunnel cases require long term, ongoing, and unlimited medical treatment [5]. Common surgical treatment for CTS usually involves the severing of the ligament around the wrist to alleviate pressure on the median nerve.

Physicians usually use open release surgery or endoscopic surgery to achieve this goal. Open release surgery is typically done under local anesthesia, and it involves making an incision of approximately two inches in the wrist to severe the carpal ligament and enlarge the carpal tunnel. Endoscopic surgery, on the other hand, has faster recovery time and minimal post-op discomfort than the open release surgery. However, it comes with a higher risk of complications. During endoscopic surgery, the physician makes about two ½ inch incisions in the wrist and palm, inserts a tube with a camera to observe ligaments and surrounding tissues. The tube also has a knife that the physician uses to nick the carpal ligament. The surgical severing of the carpal ligament relieves the pressure on the median nerve, and during recovery, the ligament can regrow. Post-operative recovery for CTS treatment usually takes several months to one to two years. Grip and pinch strength may not improve to functional conditions for three to six months. Timeline for recovery usually depends on several factors including the continuation of post-surgical therapy, the absence of nerve damage, and infection at surgical sites. [5]

Carpal Tunnel or Carpal Tunnel Syndrome (CTS) can be prevented by adopting safe ergonomic measures such as proper posture, stretching, and reducing or avoiding prolonged repetitive activities. Workers should take breaks following overuse of hand. Employers should incorporate workstations that enable workers to work in safe, natural positions.

Citations

1. Carpal Tunnel Syndrome Fact Sheet. (2019, May 14). Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet#3049_6

2. Lund, C. B., Mikkelsen, S., Thygesen, L. C., Hansson, G., & Thomsen, J. F. (2019). Movements of the wrist and the risk of carpal tunnel syndrome: a nationwide cohort study using objective exposure measurements. Occupational and Environmental Medicine, oemed-2018-105619. doi:10.1136/oemed-2018-105619

3. The Median Nerve. (2012, April 30). Retrieved from https://teachmeanatomy.info/upper-limb/nerves/median-nerve/

4. Rates of Carpal Tunnel Syndrome in a State Workers?… (2019, May 23). Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm6739a4.htm?s_cid=mm6739a4_w

5. WCI360. (2019, March 15). CDC Releases Report on Carpal Tunnel Statistics. Retrieved from https://www.wci360.com/cdc-releases-report-on-carpal-tunnel-statistics/