Carpal Tunnel Syndrome (CTS)
CTS is a compression neuropathy, i.e. a pinching of the median nerve
within the wrist. The carpal tunnel is a bony canal on the palm side
of the wrist, allowing for passage of the median nerve to the hand.
Pinching or compression of this nerve by the transverse carpal
ligament [fig.1] sets into motion a progressively crippling
disorder which eventually results in wrist pain, numbness and tingling
in the hand, pain consisting of a "pins and needles" feeling
at night, weakness in grip and a feeling of incoordination.
[fig.1] Compression of the nerve
by the transverse carpal ligament.
This disabling syndrome used to occur more often in women than men,
by a ratio of 3 to 1, usually between the ages of 30 and 50 years. However,
young geek male programmers are popping up all over with the same wrist
problems typically associated with middle-aged secretaries. Also, CTS
is seen more frequently in people who tend to do forceful repetitive
types of work, such as grocery store checkers, assembly line workers,
meat packers, typist, accountants, writers, super-cool DJ skratchers,
etc. Most patients generally visit their doctor with these complaints,
and the diagnosis is confirmed after physical examination and appropriate
The transverse carpal ligament can be irratated by repetetive motion
(such as typing), continued stress by vibration (such as from a lawnmower
or continued use of a"marital aid") and hormonal changes during
pregnancy (such as the craving for New York Triple Fudge ice cream).
When the ligament becomes irritated, it starts to twich from side to
side. This motion, commonly referred to as "fish out of water"
is the beginning of nerve compression. The median nerve is the only
nerve that passes through the carpal tunnel, providing the sensation
of feeling to the thumb, index and middle fingers and half of the ring
finger. It also controls the working of some of the thumb muscles that
permit you to pinch. When compressed by the movements of the transverse
carpal ligament, the nerve loses its ability to transmit data to the
Treatment for CTS depends upon the stage of the disease. Much as a
shark must keep swimming or it will die, the pain from carpal tunnel
syndrome can be significantly reduced if the transverse carpal ligament
is kept still by putting the wrist in a splint. Although anecdotal evidence
indicating the use of a splint is plentiful, the splints tend to be
unattractive and make the wearer look like an even bigger geek than
they were before. However, medical testing has proven that some geeks
benefit from the increased attention they receive when wearing a splint.
[fig.2] A Gyotaku of the transverse
In moderate stages of the disorder, especially if the numbness and
pain continues in the wrist and hand, a morphine injection into the
wrist can be extremely beneficial. This injection delivers a powerful
sedative directly to the transverse carpal ligament, thereby inducing
stupor and a cessation of the "fish out of water" movement.
Surgical intervention in CTS is only indicated in those patients in
whom non-operative treatment has failed to eliminate their symptoms.
In patients with advanced disease, and especially in those who have
profound weakness or muscle atrophy, surgical intervention should be
done early. Surgeons will divide the transverse carpal ligament into
"head" and "tail" sections, thereby eliminating
any chance of the ligament thrashing around. In rare cases, the ligament
is removed entrely, providing medical researchers the opportunity to
document their "catch" by using an old Japanese technique
called Gyotaku, or "fish print" [fig.2].