Orthopedics & Sports Medicine

CTS (carpal tunnel syndrome)

As I type this blog, I cannot but wonder if I’m contributing to my imminent onset of carpal tunnel syndrome. After all, Woo and her colleagues published a recent limited sample size study in Muscle & Nerve relating the causal effect of Carpal Tunnel Syndrome (CTS) to electronic device overuse. Forty–eight university students ranked as intensive and non-intensive users of the electronic devices (probably the iPhone) were clinically evaluated and determined positive CTS after a positive Phalen’s and Durkan’s test. Before we toss out our shiny new iPhone 8’s, it should be emphasized only 48 students were evaluated, an underwhelming sample size with few controls. Instead, we should rewind through the years of research that determined CTS to be the clinical idiopathic syndrome it is today.

 

Carpal tunnel syndrome is the most common entrapment neuropathy today, with a 2.0 – 5.0% prevalence. CTS involves synovial thickening and increased pressure in the carpal canal formed by the flexor retinaculum and carpal bones. In the 1900’s carpal tunnel-like syndromes, such as numbness and tingling in the fingers were thought to be a result of brachial plexopathy. Such diagnoses were treated with unsuccessful rib resections. Luckily, in the 1950’s, Phalen’s begin to diagnose and treat CTS as a median nerve neuropathy stemming from the wrist. He proposed administering steroid injections into the carpal tunnel as opposed to the brachial plexus. Common treatments still include steroid injections as well as, wrist splints, and life style modification. In more severe and clinically limiting cases of CTS, surgical treatment can include open carpal tunnel release surgery for pressure release of the median nerve.

 

While the new study argues activities, such as excessive cell-phone use can lead to CTS, there is little consensus in connecting the use of smartphones or computers with causing carpal tunnel syndrome. Traditional etiologies of CTS include, edema of the wrist, pregnancy, De Quervain’s disease, trigger finger, and congenital factors. I do not by any means promote the idea that it is completely healthy to hold and stare at our monitors for hours on end. However, it is crucial that we carefully assess the confounding variables leading to CTS so that we can best diagnosis and treat the symptoms.