Carpal Tunnel Syndrome
The pain, numbness or
tingling caused by carpal tunnel syndrome
occurs when the median nerve, which runs
from the forearm into the hand, becomes
pressed or squeezed at the wrist. The median
nerve controls sensations to the palm side
of the thumb and fingers except the
little finger. The carpal tunnel
- a narrow passageway between a broad
ligament and the carpal bones of the wrist
that surrounds the median nerve and tendons.
Frequently, the bones of the wrist move out
of place narrowing the tunnel and compress
the median nerve. Sometimes, thickening from irritated tendons
or other swelling narrows the tunnel and
causes the median nerve to be compressed.
The result may be pain, weakness, or
numbness in the hand and wrist, radiating up
the arm. Although painful sensations may
indicate other conditions, carpal tunnel
syndrome is the most common and widely known
of the entrapment neuropathies in which the
body's peripheral nerves are compressed or
traumatized.
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What are the
symptoms of carpal tunnel syndrome?
Symptoms
usually start gradually, with frequent
burning, tingling, or itching numbness in
the palm of the hand and the fingers,
especially the thumb and the index and
middle fingers. Some carpal tunnel sufferers
say their fingers feel useless and swollen,
even though little or no swelling is
apparent. The symptoms often first appear in
one or both hands during the night, since
many people sleep with flexed wrists. A
person with carpal tunnel syndrome may wake
up feeling the need to "shake out" the hand
or wrist. As symptoms worsen, people might
feel tingling during the day. Decreased grip
strength may make it difficult to form a
fist, grasp small objects, or perform other
manual tasks. In chronic and/or untreated
cases, the muscles at the base of the thumb
may waste away. Some people are unable to
tell between hot and cold by touch.
What are the
causes of carpal tunnel syndrome?
Carpal tunnel syndrome
is often the result of pressure on the
median nerve and tendons in the carpal
tunnel. Contributing factors include trauma
or injury to the wrist that cause swelling,
such as sprain or fracture; mechanical
problems in the wrist joint; work stress;
repeated use of vibrating hand tools; fluid
retention during pregnancy or menopause; or
the development of a cyst or tumor in the
canal. In some cases no cause can be
identified.
Other factors that
can contribute to carpal tunnel are nerve
irritation or pressure in the neck or
cervical spine, shoulder or elbow. All of
these areas need to be examined to rule out
the possible involvement.
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Who is at risk of
developing carpal tunnel syndrome?
Women are three times more
likely than men to develop carpal tunnel syndrome,
perhaps because the carpal tunnel itself may be
smaller in women than in men. The dominant hand is
usually affected first and produces the most severe
pain. Persons with diabetes or other metabolic
disorders that directly affect the body's nerves and
make them more susceptible to compression are also
at high risk. Carpal tunnel syndrome usually occurs
only in adults.
The risk of developing
carpal tunnel syndrome is not confined to people in
a single industry or job, but is especially common
in those performing assembly line work -
manufacturing, sewing, finishing, cleaning, and
meat, poultry, or fish packing. In fact, carpal
tunnel syndrome is three times more common among
assemblers than among data-entry personnel. A 2001
study by the Mayo Clinic found heavy computer use
(up to 7 hours a day) did not increase a person's
risk of developing carpal tunnel syndrome.
During 1998, an estimated
three of every 10,000 workers lost time from work
because of carpal tunnel syndrome. Half of these
workers missed more than 10 days of work. The
average lifetime cost of carpal tunnel syndrome,
including medical bills and lost time from work, is
estimated to be about $30,000 for each injured
worker.
How is carpal tunnel
syndrome diagnosed?
Early diagnosis and treatment
are important to avoid permanent damage to the
median nerve. A physical examination of the hands,
arms, shoulders, and neck can help determine if the
patient's complaints are related to daily activities
or to an underlying disorder, and can rule out other
painful conditions that mimic carpal tunnel
syndrome. The wrist is examined for tenderness,
swelling, warmth, and discoloration. Each finger
should be tested for sensation, and the muscles at
the base of the hand should be examined for strength
and signs of atrophy. Routine laboratory tests and
X-rays can reveal diabetes, arthritis, and
fractures.
Physicians can use specific
tests to try to produce the symptoms of carpal
tunnel syndrome. In the Tinel test, the doctor taps
on or presses on the median nerve in the patient's
wrist. The test is positive when tingling in the
fingers or a resultant shock-like sensation occurs.
The Phalen, or wrist-flexion, test involves having
the patient hold his or her forearms upright by
pointing the fingers down and pressing the backs of
the hands together. The presence of carpal tunnel
syndrome is suggested if one or more symptoms, such
as tingling or increasing numbness, is felt in the
fingers within 1 minute. Doctors may also ask
patients to try to make a movement that brings on
symptoms.
How is carpal tunnel
syndrome treated?
Surgery has been commonly used
to release the pressure on the nerve by cutting the
broad ligament in the wrist allowing the carpal to
spread reducing pressure on the nerve but if the
problem is properly diagnosed and treated surgery
can usually be avoided. Treatments for carpal tunnel
syndrome should begin as early as possible, under a
doctor's direction. Underlying causes such as
diabetes or arthritis should be treated first.
Treatment generally involves specialized physical
therapy directed toward taking the pressure off the
nerve at the wrist by maneuvers and exercise that
can reduce the inflammation and pressure on the
median nerve. Along with stretching the muscles and
ligaments of the forearm and hand. Indications on
whether physical methods are effective will
generally take only 2-5 treatments although complete
resolution can take longer.
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