Most people take hand function for granted. Gripping, grabbing, holding and reaching come naturally. And no one imagines losing those abilities.

Carpal tunnel syndrome (CTS ) changes expectation when it robs hands of their strength and dexterity.

CTS is common in the work place. Other activities, such as golfing, gardening, driving and yes even weight lifting can cause CTS. But it can be avoided.

The “carpal tunnel” is comprised of bones and ligaments surrounding nine flexor tendons and the median nerve. Carpal tunnel syndrome is caused by compression of the median nerve in the carpal tunnel area of the wrist. The median nerve, located directly under the transverse carpal ligament, is a superficial, soft structure in the tunnel, which makes it susceptible to compressive forces. When the synovium around tendons swells or thickens, it creates tissue irritation and inflammation, placing pressure on the bones and ligaments. As carpal tunnel pressure increases, the median nerve compresses and can’t function normally.

Symptoms of carpal tunnel often go unnoticed or brushed off as pain that should eventually subside. Pain, tingling, numbness or weakness in the thumb, middle or ring finger can indicate CTS, as well as pain radiating from the hand up the arm. Other signs include a tight, swollen feeling in the hands and wrist. People also may develop a tendency to drop objects because of pinching or grasping deficiencies. As the condition worsens, people lose strength and can’t manage basic functional tasks, such as opening a jar or writing.

Any movement or condition that causes swelling in the carpal tunnel area is considered a risk factor for CTS. For instance, diseases or illnesses, such as diabetes, lupus, rheumatoid arthritis or hypothyroidism, can cause CTS.

In addition, women between 40 and 60 are at high risk. Pregnant women also can develop temporary CTS symptoms. CTS is common following wrist fractures.

How can you prevent CTS? In the early stages of CTS, you can reverse the effects simply by stopping or reducing an activity that aggravates the median nerve. Conservative treatment is the most valuable form of rehab. At this stage, splinting can be an effective prevention method if it’s provided within three months of symptom onset.

Other preventive strategies include performing stretching exercises, taking frequent rest from an activity, and using correct posture during functional tasks.

Correct positioning is paramount. Studies have shown that when wrist are in normal flexion or extreme extension, pressure increases in the carpal tunnel 10 to 15 times. So, it’s not surprising that people experience carpal tunnel syndrome when they fall asleep with the wrist flexed and tucked under their chin. Results from studies also show an increased CTS risk when assembly line workers are required to flex or extend wrists to accomplish job tasks.

Another study indicates that pressure increases with metacarpal phalangeal ( MP ) flexion and interphalangeal extension. This helps explain why some people may experience intermittent carpal tunnel symptoms.

External pressure in the carpal tunnel area can also be a contributing factor. If treatment is sought within three months of experiencing carpal tunnel symptoms, the condition can easily be reversed with conservative rehab measures. Unfortunately, most people wait until the condition becomes extremely painful and experience numbness, and motor deficits. At this point, damage to the median nerve has already occurred.

If preventative measures don’t work, CTS can be treated nonsurgically or surgically. Nonsurgical treatments can include physical therapy, anti-inflammatories or cortisone injections directly into the wrist. Physical therapy can include specific stretching techniques for the wrist and hand, edema control, ultrasound and iontophoresis (introducing medication through the skin without needles).

If this is not effective than surgical intervention is required, either through an open technique or endoscopically. Surgery may be the best chance to restore normal daily activities that have been hindered by persistent loss of feeling, coordination and strength.

With the open technique, a surgeon makes an incision at the wrist, then cuts the transverse carpal ligament to relieve carpal tunnel pressure. An open incision allows the doctor to see more of the anatomical structures, but it also disturbs more tissue.

With an endoscopic procedure, a surgeon makes two small incisions large enough for a one or two portal release. This technique is less invasive and has a faster recovery period.

Post-operative care should include edema control, wound care and motion exercises for tendon and nerve gliding. Carefully monitor tissue inflammation. Post-operative wrist splint can prevent hand overuse and overstretching of newly repaired tissue.

As tissue healing occurs, light hand use should be encouraged with a gradual return to easy ADL tasks over two to four weeks.

But avoid immediate strengthening exercises and repetitive gripping and pinching during this stage. In time, implement isometric exercises and slowly strengthen the hand as tolerated through normal daily use.