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Carpal Tunnel Syndrome

Carpal tunnel syndrome is a disorder in which the median nerve is compressed at the wrist causing symptoms like tingling, pain, coldness, and sometimes weakness in parts of the hand. It is the most famous of a class of disorders called repetitive strain injuries.

Symptoms

The first symptoms usually appear at night. Symptoms range from a burning, tingling numbness in the fingers (especially the thumb and the index and middle fingers) to difficulty gripping, making a fist, or dropping things.

Causes

Some cases of carpal tunnel syndrome are due to work-related cumulative trauma of the wrist. It is commonly caused by strain placed on the hand, for instance gripping and typing, which are usually performed repetitively in a person's occupation.

There are a number of causes of carpal tunnel syndrome. They can be either traumatic, or non-traumatic. Trauma-based causes:

  • Repetitive stress induced carpal tunnel strain is the leading cause of Carpal Tunnel Syndrome in most industrialized countries. In the USA for instance, repetitive stress induced CTS is the biggest single contributoring factor to lost time at work. This type of CTS results in billions of dollars of workers compensation claims every year.
  • Fractures of one of the arm bones, particularly a Colles' fracture.
  • Dislocation of one of the carpal bones of the wrist.
  • Hematoma forming inside the wrist, because of internal haemorrhaging.
  • Deformities due to abnormal healing of old bone fractures.

Non-traumatic causes, generally happen over a period of time, and are not triggered by one certain event. Examples include:

  • Tenosynovitis, which is inflammation of the joint. Part of the process of inflammation is swelling, and this compresses the nerve.
  • With pregnancy and hypothyroidism, fluid is retained in tissues, which swells the joint.
  • Acromegaly, a disorder of growth hormones, compresses the nerve by the abnormal growth of bones around the hand and wrist.
  • Tumours (though not necessarily cancer), such as a ganglion or a lipoma, can protrude into the carpal tunnel, reducing the amount of space.
  • Diabetes, rheumatoid arthritis, and obesity tend to cause swelling, thus decreasing the amount of space in the carpal tunnel.
  • Idiopathic causes, which no-one can explain, can also cause this disease.

Common activities that have been identified as contributing to repetitive stress induced CTS include:

  • Computer Keyboarding or typing
  • Playing a musical instrument
  • Driving a vehicle, motorcycle or flying a plane
  • Any activity where hand use is vigorous and routine could contribute.
  • An exhasutive list can be found in the external links below

Often people suffering from CTS 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 injuries.

Diagnosis

Tinel's sign is a way to detect irritated nerves. It is performed by lightly banging (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve. In a person with carpal tunnel syndrome where the median nerve is compressed at the wrist, Tinel's sign is often "positive" and causes tingling in the thumb, index, and middle fingers. Tinel's sign is sometimes referred to as "distal tingling on percussion" or DTP.

Phalen's maneuver is another test for carpal tunnel syndrome. The patient is asked to keep their wrist at the extremity of flexion for 30 seconds. The aim is to compress the carpal tunnel and thus elicit the characteristic symptoms of the carpal tunnel syndrome. If the patient experiences a burning, tingling or numb sensation over the thumb, index, middle and ring fingers, then the test is positive. Phalen's maneuver is more sensitive than Tinel's sign.

Treatment

In general, if a specific action or movement (such as typing on a keyboard, or gripping a hammer) is causing pain, then simply avoiding this action may be enough to alleviate symptoms. Unfortunately, this doesn't always work and a person's job may preclude simply stopping.

Carpal tunnel syndrome is treated by immobilizing the wrist in a splint to minimize or prevent pressure on the nerves (the use of splints for anything other than a short time is considered by many to be non productive).

If that fails, patients are sometimes given anti-inflammatory drugs or injections of cortisone in the wrist to reduce the swelling.

Carpal tunnel syndrome can also be treated non-surgically through the use of Active Release Techniques also known as Soft Tissue Therapy. The purpose of Active Release Techniques is to reduce the scar tissue adhesions, increase muscle elasticity, and increase strength. Also, new breakthroughs in Soft Tissue Therapy have been developed in recent years by physicians to reduce compression of the median nerve in the carpal tunnel allowing sufferers to gain control over their symptoms and avoid surgery. Physicians and medical insurance providers recommend exhausting all conservative treatment options before resorting to surgery.

There is also a surgical procedure in which doctors can open the wrist and cut the ligament (the flexor retinaculum) at the bottom of the wrist to relieve the pressure. However, only a small percentage of patients require surgery. The surgery itself is very brief, and only a local anaesthetic is needed. Full recovery however, can take up to three months. This surgery can also be done endoscopically.

Long Term Recovery

Approximately 1 percent of individuals with carpal tunnel syndrome develop permanent injury. The majority recover completely and can avoid reinjury by changing the way they do repetitive movements, the frequency with which they do the movements, and the amount of time they rest between periods when they perform the movements.

Anatomy of Carpal Tunnel

The median nerve runs through the carpal tunnel, a canal in the wrist that is surrounded by bone on three sides, and a fibrous sheath (the flexor retinaculum) on the other. As well as the nerve, many of the hand's tendons pass through this canal. The median nerve can be compressed by swelling of the contents of the canal, or by direct pressure from part of a broken or dislocated bone.

Disclaimer: Information shared in this section is indicative. Please do not make any conclusion and we strongly recommend you to consult with your Doctor. Symptoms may vary with individual, geography, climate and lifestyle