Carpal tunnel syndrome causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Carpal tunnel syndrome is the most common entrapment neuropathy, affecting 2-10% of adults in the general population. The underlying cause of CTS is not well known yet but trauma, repetitive maneuvers, certain diseases, and even pregnancy are known to be causes in this regard. In most cases the CTS is found idiopathic. Meanwhile .
Causes
Etiologies of Carpal Tunnel Syndrome
| Repetitive maneuvers |
| Obesity |
| Pregnancy |
| Arthritis |
| Hypothyroidism |
| Diabetes mellitus |
| Trauma |
| Mass lesions |
| Amyloidosis |
| Sarcoidosis |
| Multiple myeloma |
| Leukemia |
The international debate regarding the relationship between CTS and repetitive motion and work is ongoing. The Occupational Safety and Health Administration (OSHA) has adopted rules and regulations regarding cumulative trauma disorders. Occupational risk factors of repetitive tasks, force, posture, and vibration have been cited. However, the American Society for Surgery of the Hand has issued a statement that the current literature does not support a causal relationship between specific work activities and the development of diseases such as CTS.
The relationship between work and CTS is controversial; in many locations workers injured at work are entitled to time off and compensation. Many cases of carpal tunnel syndrome are provoked by repetitive grasping and manipulating activities, and the exposure can be cumulative. Symptoms are commonly exacerbated by forceful and repetitive use of the hand and wrists in industrial occupations. Carpal tunnel syndrome results in billions of dollars of workers compensation claims every year.
Studies done by the National Institute for Occupational Safety and Health (NIOSH), indicated that job tasks involving highly repetitive manual acts or necessitating wrist bending or other stressful wrist postures were connected with incidents of CTS or related problems. However, it appears that the 30+ studies reviewed were concerned with the occupations of assembly line workers, meat packers, food processors, and the like, not general office work.
In addition, a 2005 study found that people who have discomfort at the base of the neck or in the shoulder or work with their shoulder in elevation (indicators of poor working postures) are more likely to develop a repetitive overuse injury. These factors can affect the biomechanics of the upper limb or tissue tolerance to repetitive tasks resulting in injury, or both. Postural and spinal assessment along with ergonomic assessments should be included in the overall determination of the condition. Addressing these factors have been found to improve the status of work related upper limb injuries.
Hypothyroidism, osteoarthritis and diabetes were most often associated with CTS-like symptoms, as were variables such as age, obesity and wrist dimension. In a 1998 study, only 35 of 297 subjects were aware of the underlying health condition which could account for their CTS-like symptoms. Hence, these causes would be missed by doctors if they were relying on a patient's health history to rule out other causative factors. It is important that a doctor rule out other causes of CTS-like symptoms. If a patient does not have CTS, corrective surgery is destined to fail.
Studies have also related carpal tunnel and other upper extremity complaints with psychological and social factors. A large amount of psychological distress showed doubled risk of the report of pain, while job demands, poor support from colleagues, and work dissatisfaction also showed an increase in the report of pain, even after short term exposure. A minority viewpoint holds that stress is the main cause, rather than a contributing factor, of a large fraction of pain symptoms usually attributed to carpal tunnel syndrome.
- Fractures of one of the arm bones, particularly a Colles' fracture.
- Dislocation of one of the carpal bones of the wrist.
- Strong blunt trauma to the wrist or lower forearm, incurred for example by using arm extremity to cushion a fall or protecting oneself from falling heavy objects.
- Hematoma forming inside the wrist, because of internal hemorrhaging.
- Deformities due to abnormal healing of old bone fractures.
Misalignment between carpal bones should be the most common cause of CTS, because by adjusting these bones' alignment, CTS dramatically decreases
Non-traumatic
Non-traumatic causes generally happen over a period of time, and are not triggered by one certain event. Many of these factors are manifestations of physiologic aging and should not be considered preventable. Examples include:
- Tenosynovitis, which is inflammation of the thin mucinous membrane around the tendons. Part of the process of inflammation is swelling, and this compresses the nerve. Swelling of this membrane is the final common pathway for most cases of carpal tunnel, whether caused idiopathically, through exposure, or medically.
- With pregnancy and hypothyroidism, fluid is retained in tissues, which swells the tenosynovium.
- Acromegaly, a disorder of growth hormones, compresses the nerve by the abnormal growth of bones around the hand and wrist.
- Tumors (usually begin), such as a ganglion or a lipoma, can protrude into the carpal tunnel, reducing the amount of space. This is exceedingly rare (less than 1%).
- Double crush syndrome, where there is compression or irritation of nerve branches contributing to the median nerve in the neck or anywhere above the wrist. This then increases the sensitivity of the nerve to compression in the wrist. This, while a possible factor, is also a rare contributor in most cases.
- Idiopathic causes are common.
- Common activities that have been identified as contributing to repetitive stress induced carpal tunnel syndrome include:
- Use of power tools
- Construction work such as handling many bricks, stone and/or lumber
Often people suffering from carpal tunnel syndrome can have multiple contributing factors which are aggravated by vigorous hand activities and repetitive stress trauma to the hand.
Proper attention to ergonomic considerations can reduce or eliminate these kinds of exposures.
While carpal tunnel syndrome is often called a "repetitive strain injury" (RSI) or "cumulative trauma disorder" (CTD), these labels are discouraged by physicians, particularly hand specialists. Carpal tunnel is a specific condition with specific symptoms that responds fairly reliably. Most of the time, carpal tunnel is not caused by a "strain" or "trauma" of any type. RSI and CTD are relatively non-specific terms with non-specific symptoms that respond variably to treatment.
Life Threatening Causes
Common Causes
- Hypothyroidism
- Diabetes
- Acromegaly
- Idiopathic carpal tunnel syndrome
- Pregnancy
- Wrist trauma
Causes by Organ System
Causes in Alphabetical Order
- Acromegaly
- Alpha-l-iduronidase deficiency
- Amyloidosis
- Aromatase inhibitors
- Arthritis
- Chronic kidney failure
- Colles' fracture
- Connective tissue diseases
- Diabetes
- Distal radius fracture
- Estrogen
- Fluid retention from menopause
- Fluid retention from pregnancy
- Growth hormone secreting pituitary adenoma
- Hand surgery
- Hemodialysis
- Hypertension
- Hypothyroidism
- Idiopathic
- Increased body mass index
- Lithium poisoning
- Median nerve compression
- Menopause
- Mucolipidosis iii
- Multiple myeloma
- Musculoskeletal problems of the wrist and hand
- Mycobacterium tuberculosis
- Myeloma
- Myxedema
- Neuropathy hereditary with liability to pressure palsies
- Obesity
- Occupational vibrational exposure
- Oral contraceptives
- Osteoarthritis
- Osteomyelitis
- Pituitary tumors
- Preexisting median mononeuropathy
- Pregnancy
- Prolonged wrist extension and flexion
- Recurrent hereditary polyserositis
- Repetitive hand and wrist use
- Repetitive motions
- Repetitive strain injury wrist joint
- Rheumatoid arthritis
- Rheumatoid disease
- Still disease
- Stress
- Sustained wrist or palm pressure
- Tenosynovitis
- Thyroid dysfunction
- Urate crystal arthropathy
- Vibrating tools
- Work-related repetition
- Wrist bone dislocation
- Wrist fracture
- Wrist hematoma
- Wrist inflammations
- Wrist injury
- Wrist trauma
- Wrist arthritis